Oncology & Hematology Coding Alert

Question: What's the difference between modifiers -GV and -Q5?

New Orleans Subscriber

Answer: You should use modifier -GV (Attending physician not employed or paid under arrangement by the patient's hospice provider) when an attending physician provides services for a hospice patient but doesn't work for the hospice. Medicare doesn't consider services provided by such physicians as "hospice services." Therefore, if you attach modifier -GV, you can prevent claim delays or denials.

Example: You submit G0182 (Physician supervision of a patient under a  Medicare-approved hospice ...) to Medicare for an attending physician who provides treatment and management services of a hospice patient's terminal illness, such as advanced colon cancer (153.x). But the physician wasn't affiliated with the hospice center, so you should append modifier -GV to G0182.

When you want to indicate a reciprocal billing agreement, you should report modifier -Q5 (Service furnished by a substitute physician under a reciprocal billing arrangement). To submit claims for services a covering physician(s) provides, the primary physician should attach modifier -Q5 to the appropriate CPT code. You should use this modifier for all dates of services. For instance, if your oncologist scheduled a patient for chemotherapy administration (96410, ... infusion technique, up to one hour), the substitute physician may conduct his own brief exam and check the patient's history. Although the substitute oncologist provided face-to-face care, your oncologist may still bill for the chemo services. In that case, you would report 96410-Q5.

-- Answers to Reader Questions and You Be the Coder were provided by Linda L. Lively, MHA, CCS-P, RCC, CHBME, founder and CEO of American Medical Accounting and Consulting in Marietta, Ga.; and Margaret M. Hickey, MS, MSN, RN, OCN, CORLN, an independent coding consultant based in New Orleans.