Urology Coding Alert

Question: Our urologist performed a dorsal slit for a hospitalized patient on the hospice service. Medicare denied payment for this service because the patient was enrolled in hospice for chronic obstructive pulmonary disease (COPD). Since his urological problem (phimosis) is unrelated to his COPD, can we not get paid for the dorsal slit procedure? Is there a way to accurately code this scenario to ensure proper payment?

Pennsylvania Subscriber

Answer: You should report the services your urologist performed using modifier GW (Service not related to the hospice patient's terminal condition). You'll use modifier GW when your urologist 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 urologist is often called upon to see hospice patients in a hospital setting for a problem that's unrelated to the hospice diagnosis. In these cases, you'll need to append modifier GW to all CPT codes 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 urologist is performing services for a hospice patient, and he is designated as the attending physician.