Ophthalmology and Optometry Coding Alert

Question: While I was away, my ophthalmologist saw a hospice patient. He left a note on the encounter stating there is a procedure for billing this. I have not done this before and need help.


Nevada Subscriber

Answer: You'll need to append one of two modifiers to the procedure code: -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.