Hospice Modifiers GV and GW for Successful Wound Care Billing

Hospice is a specialized care type for people with terminal illnesses. Hospice care addresses the patient’s emotional, physical, social, and spiritual needs. In simple terms, hospice is a complete, all-encompassing program of care and support for terminally ill patients and their families. Hospice care shifts the emphasis from curative care to comfort care (palliative care) for pain reduction and symptom management. To ensure that hospice patients get timely wound care and physicians receive complete reimbursement, it is crucial to understand the use of hospice modifiers for successful wound care billing.

Let’s have a glimpse at hospice modifiers for accurate and successful wound care billing:

What are the requirements of hospice modifiers for wound care?

The Hospice Modifiers can be utilized when:

  • Patients are engaged in hospice and are expected to pass away within the next six months.
  • A physician treats a hospice patient to indicate that a separate payment should be allowed.
  • The hospice or any condition unrelated to the patient’s terminal state does not pay the physician.
  • The hospice care facility is meant to provide the patient’s care.
  • The hospice benefit provisions only cover care provided by a Medicare-certified hospice.

When to use the GV and GW modifiers in hospice work?

When a physician provides a service linked to the diagnosis for which a patient has been registered in hospice, the GV modifier is applied. This physician is not affiliated with the hospice but serves as the attending physician.

When a physician provides a treatment that is unrelated to the diagnosis for which a patient has been enrolled in hospice, the GW modifier is used. This physician is not affiliated with the hospice but serves as the attending physician.

What are the coding guidelines for hospice modifiers for wound care?

When paying for services provided to a hospice patient, modifiers GV and GW should be applied. The hospice modifier to use depends on who is providing the service, what services are being offered, and if the services are for/related to the cause the patient is enrolled in hospice.

Modifier GV

Regardless of provider type, modifier GV must be submitted when a service matches the following conditions:

  • The service was provided to a hospice patient.
  • A physician or non-physician practitioner delivered the service recognized as the patient’s attending physician at the time of enrollment in the hospice program.

In the following cases, avoid submitting the GV modifier:

  • A physician appointed by the hospice performed the service.
  • The service was delivered by a physician who was not employed by the hospice, and the beneficiary did not identify him as his attending physician.

Modifier GW

When the claims are submitted to the Part A contractor to treat a non-terminal ailment with condition code 07, all providers must submit the GW modifier. Ensure that an accurate diagnosis is entered on the claim. If modifier GW was correctly applied, it may be necessary to challenge the verdict.

Outsourcing for Successful Wound Care Billing!

Claim denials can result in numerous additional administrative hours and potentially millions of dollars in revenue lost. A methodical approach to compliant billing and internal auditing enables providers to self-correct and avoid infractions from escalating.

An expert hospice revenue cycle management company such as 24/7 Medical Billing Services can help guarantee that all of your hospice claims are adequately paid and submitted, resulting in accurate reimbursement for the treatment you offer to your patients. We provide you with a staff of highly qualified and experienced billers who employ best practices to handle your practice’s complex billing needs. We also assist hospice organizations with end-to-end revenue cycles management services like billing and coding, A/R follow-up, and denial management.

See also: Billing And Coding For Skin Substitute Grafts

Let us know what you need!

Error: Contact form not found.