Practice Management Alert

Question: We have a patient our physician performed an incision and drainage procedure on. The EOB came back saying they would not pay because he is in hospice. I contacted the hospice people and they said that they should pay because this procedure had nothing to do with why he is in hospice. He is in hospice because of COPD. She said there should be a code to use (maybe a modifier) or something to let the insurance company know that this is not a hospice problem? What we should be using to bill this correctly?

Pennsylvania Subscriber

Answer: You should report the services your physician performed using modifier GW (Service not related to the hospice patient's terminal condition). You'll use modifier GW when your physician is performing services not related to the hospice diagnosis -- in this case, anything unrelated to the patient's chronic obstructive pulmonary disease (COPD).

Typically, just as in your case, a specialty physician is usually called upon to see hospice patients in a hospital setting for a problem that's unrelated to the reason for which he's in the hospice. In these cases, you'll need to append modifier GW to ensure payment.

Avoid confusion: Don't let modifier GV (Attending physician not employed or paid under agreement by the patient's hospice provider) throw you off. You'll append modifier GV if your physician is performing services for a hospice patient, and he is designated as the attending physician.