Modifier Coding Alert

Question: My physician has an established 85-year-old patient who lives at home and has recently been placed on hospice. My doctor is the patient’s PCP. She made a home visit last week to see her patient on a matter related to the reason for hospice. What hospice code should I use for the PCP and do I need modifier GW?

Maryland Subscriber

Answer: You should report 99378 (Supervision of a hospice patient [patient not present] requiring complex and multidisciplinary care modalities involving regular development and/or revision of care plans by that individual, review of subsequent reports of patient status, review of related laboratory and other studies, communication [including telephone calls] for purposes of assessment or care decisions with health care professional[s], family member[s], surrogate decision maker[s] [eg, legal guardian] and/or key caregiver[s] involved in patient’s care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 30 minutes or more) because your physician is the patient’s primary care physician (PCP).

For the home visit, you will report the appropriate level of service from the 99347-99350 (Home visit for the evaluation and management of an established patient, …) range. You wouldn’t attach modifier GW (Service not related to the hospice patient’s terminal condition) unless the physician is seeing the patient for a condition that isn’t related to the patient’s terminal condition.