Gw Modifier For Care Unrelated to Hospice concluding Care

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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 easily there is a modifier, Gw, that indicates that the care is unrelated to the patient's final condition. In order for a patient to receive Hospice services they must have a life expectancy of six months or less if the final illness or disease runs its normal course.

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Many citizen mistakenly think that this means that the patient must be bed ridden or critically ill. However, that is not all the time the case. In fact, many hospices encourage the patients to continue with public 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 curative provider for something that is not connected to the final condition. For example, maybe the patient has low back pain and finding a chiropractor gives the patient relief. Their final condition is an inoperable brain tumor, or an inoperable aortic aneurysm. The back pain is not connected to the final 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 guarnatee using the Gw modifier to indicate "service not connected to the hospice patient's final condition".

There are other examples of care that can be rendered that is not connected to the final condition. Maybe the patient gets conjunctivitis and needs to see an ophthalmologist to get treatment. Again, the assistance is unrelated to the final condition, but you can't just ignore the conjunctivitis.

For me the qoute 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 curative Billing Inc 

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