Many billers think that if a patient is a Hospice patient that they cannot get reimbursed for services if they are not reimbursed by the Hospice carrier. But actually there is a modifier, GW, that indicates that the care is unrelated to the patient’s terminal condition. In order for a patient to receive Hospice services they must have a life expectancy of six months or less if the terminal illness or disease runs its normal course.
Many people mistakenly think that this means that the patient must be bed ridden or critically ill. However, that is not always the case. In fact, many hospices encourage the patients to continue with social and recreational activities as long as they are able. They try to make the patient’s last few months, or weeks as fulfilling as possible.
This in some cases means that the patient may need to see a medical provider for something that is not related to the terminal condition. For example, maybe the patient has low back pain and seeing a chiropractor gives the patient relief. Their terminal condition is an inoperable brain tumor, or an inoperable aortic aneurysm. The back pain is not related to the terminal condition. The patient receives relief from the chiropractic manipulation.
The chiropractor can still see the patient even though they are receiving hospice and the chiropractor doesn’t have to get hospice to agree to pay for the care. They can bill the patient’s insurance using the GW modifier to indicate “service not related to the hospice patient’s terminal condition”.
There are other examples of care that can be rendered that is not related to the terminal condition. Maybe the patient gets conjunctivitis and needs to see an ophthalmologist to get treatment. Again, the service is unrelated to the terminal condition, but you can’t just ignore the conjunctivitis.
For me the problem is that I use the GW modifier so infrequently that when I need it I can’t remember which modifier it is. So I decided to make it an entry in my rolodex so that when it comes up, I can find it easily! Hey, whatever works.
Copyright 2009 – Michele Redmond
Solutions Medical Billing Inc