Urology Coding Alert

If your urologist sees and treats hospice patients, you probably feel like you have to jump through hoops to get paid. The key to bringing in every hospice-related dollar your urologist deserves is ensuring you append the right modifier.

When reporting services your urologist provides to a hospice enrolled patient, "the most important thing you need to pay attention to is the correct modifier to use," says Jane Marks, financial services manager at Anne Arundel Urology in Annapolis, Md. "You also need to pay attention to the diagnosis that is on your claim and whether that diagnosis is related to the terminal illness or not."

The diagnoses the hospice submits for its patients affect how you bill and what reimbursement (if any) your urologist will receive. If you know which diagnosis the hospice uses, you'll know whether to append modifier GV (Attending physician not employed or paid under agreement by the patient's hospice provider) or modifier GW (Service not related to the hospice patient's terminal condition).

Here's how: If your urologist is performing services for a hospice patient, and he is designated as the attending physician, use modifier GV. Note that your urologist cannot be employed by the hospice or have a separate payment arrangement with the hospice if you're using modifier GV.

"This modifier is not commonly used by a urologist," Marks cautions. "The attending physician is defined as the doctor having the largest role in the determination and delivery of the patient's care. This would more commonly be the PCP [primary care physician] or perhaps oncologist versus a urologist."

Alternative: You'll use modifier GW when your urologist is performing services not related to the hospice diagnosis, Marks says. Typically, a urologist is usually called upon to see hospice patients in a hospital setting for a problem that's unrelated to the reason he's in the hospice. In these cases, you'll need to append modifier GW to ensure payment.

Example: Your urologist is seeing a hospice patient for a kidney stone when the patient's terminal illness is cervical cancer. For this service, you would attach modifier GW to the codes you report for the services your urologist performed and documented.

As a last resort, you can always bill the hospice directly for your urologist's services, and the hospice can bill the payer on your behalf. "It is a good idea to have agreements with some of the hospice providers in your area so if your provider is asked to care for a hospice patient and their insurance carrier will not cover those charges, the hospice will pay the provider directly for their services, usually at Medicare rates," Marks explains.