Primary Care Coding Alert

Question: We referred a patient to hospice for lung cancer, but we are still treating her for diabetes and hypertension. Medicare denied the claim because the patient is enrolled in hospice. We did not use the lung cancer diagnosis code because we saw the patient for an entirely different problem. How can we get paid for this?

California Subscriber

Answer: Append the -GW modifier (Service not related to the hospice patient's terminal condition) to the E/M office visit code. This HCPCS modifier, which Medicare established specifically for this purpose, tells the carrier that you are not treating the patient for his or her terminal condition. It will allow you to use the appropriate diabetes (250.00-250.93) and hypertension (401.0-405.99) diagnosis codes and receive reimbursement.