Ophthalmology and Optometry Coding Alert

Question: We have a new ophthalmologist in our practice who is going to be seeing hospice patients. I've never had to code for hospice services before and I know there are special modifiers. Would you explain how to use them?

New Hampshire Subscriber

Answer: You'll need to append one of two modifiers to the procedure codes you'll report for the ophthalmologist's hospice services: GV (Attending physician not employed or paid under arrangement by the patient's hospice provider) or GW (Service not related to the hospice patient's terminal condition).

You should use modifier GV when the ophthalmologist provides services related to a hospice patient's terminal illness. But the ophthalmologist should neither work for nor receive compensation from the hospice service.

When an ophthalmologist, who may or may not work for the hospice, treats a patient for conditions unrelated to a terminal illness, you can use modifier GW.

Example: Your ophthalmologist treats a hospice patient for conjunctivitis (372.10), a condition that's unrelated to the patient's terminal cancer. In this case, you should use GW, regardless of whether the ophthalmologist works for the hospice. You can find additional information in the Medicare Claims Processing Manual, Chapter 11, Sections 40.2.2 (B) and 50.