Pathology/Lab Coding Alert

Question: We’re getting denials from Medicare when we append hospice modifier GW to G2024. What could be the problem?

Mississippi Subscriber

Answer: The problem you’re having could be due to a number of factors, depending on what type of provider and patient are involved in the claim. Only independent laboratories can bill G2024 (Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a snf or by a laboratory on behalf of a hha, any specimen source). If you’re billing for a different type of provider, that may be the problem.

Labs can bill code G2024 when trained lab personnel travel to collect a COVID-19 test specimen from a patient in a skilled nursing facility (SNF) or on behalf of a request from a home health agency (HHA). But for SNF billing, the patient must be in a non-covered SNF stay for you to bill G2024, because lab tests are bundled in Medicare covered stays. The collection must involve more than a pickup service, such as performing a nasal swab and properly containing the specimen.

You cannot bill G2024 for collecting the specimen from hospital inpatients or outpatients. For collecting a specimen from a hospital outpatient and billing under the Outpatient Prospective Payment System (OPPS), you should have been reporting C9803 (Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source) since March 1, 2020. Billing these services with G2024 will result in a returned claim with edit W7062.

Modifier GW (Service not related to the hospice patient’s terminal condition) applies when a healthcare practitioner provides a service that is not involved in the patient’s hospice-related diagnosis. You should use the modifier when billing for a physician or other appropriate healthcare provider who is not an employee of the designated hospice. This modifier would not ordinarily apply to laboratory personnel.