Ophthalmology and Optometry Coding Alert

Question: Medicare recently denied a service that our ophthalmologist provided to a patient in hospice care. Can we bill the hospice for the services our physician provided, or should we try the insurance payer to pay for the services rendered? Illinois Subscriber

Answer: The hospice is not liable to pay for the services your ophthalmologist rendered unless your practice and the hospice had a prior arrangement spelling that out.

In the absence of such an agreement, you should examine what went wrong with your claim and try to resubmit it to make the claim more accurate. If your eye care physician is not employed by the hospice or paid by it, you may need to append modifier GV (Attending physician not employed or paid under arrangement by the patient’s hospice provider) to the claim to let the insurance payer know that the hospice is not reimbursing your ophthalmologist in any manner for the services rendered. This will also inform the payer that the hospice is not eligible to bill for the services rendered by your ophthalmologist. Coverage may exist, however, if the service involves address a different diagnosis than why the patient is in hospice care.