By Jimmie Hebert, CPC, CMCA-EM, CMC, CMOM, CMIS
To ensure seamless billing compliance, clinical documentation for hospice patients must explicitly state whether the encounter is related or unrelated to the terminal condition.
Clearly detailing this clinical relationship allows our coding team to assign the correct modifiers accurately, preventing administrative delays and claim denials.
GV Modifier: Used by an independent, attending physician to indicate that the service provided IS RELATED to the patient's terminal condition. This lets Medicare know to bill the service under Part B separately rather than through the hospice's bundled payments.
This modifier should be used by the attending physician when:
The service(s) provided are related to the patient’s terminal condition.
GW Modifier: Used when an item or service provided to a hospice patient is NOT RELATED to their terminal illness or hospice condition. This modifier is placed after the appropriate CPT code and ensures the provider can bill for treating separate medical issues.
This modifier should be used by the attending physician when:
The service(s) provided are unrelated to the patient’s terminal condition.