Wiki Help for billing code 99375 medicare

[Lesia Griffin]

I am getting denials from medicare for codes 99374-99375, stating that I am using the incorrect modifier...I have been using Modifier "GV"...Medicare denies this for inconsistency...any suggestions as to what modifer will get my claims paid? Any help appreciated...

 

[dclark7]

There ar different codes depending on the patient's setting, 99374-75 are for patients under the care of a home health agency, 99377-78 are for hospice patients and 99379-80 are for nursing home patients. Modifier GV states "Attending physician not employed or paid under arrangement by the patient's hospice provider". If the patient is enrolled in a hospice, then the correct code would be 99377 or 99378 rather than 99374-99375. If the patient is not enrolled in a hospice then you do not need the GV modifier.

 

[csandri]

Care Plan Oversite

For Medicare patients in an assissed living facility use G0182, Medicare will not pay for care plan oversites for nursing facilites any longer.

 

[llrchavez]

99374/75

My clearing house is denying these codes, and they are not included on the Medicare Fee Schedule. Patient is not hospice