Gw Modifier For Care Unrelated to Hospice final Care

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Many billers think that if a inpatient is a Hospice inpatient that they cannot get reimbursed for services if they are not reimbursed by the Hospice carrier. But positively there is a modifier, Gw, that indicates that the care is unrelated to the patient's concluding condition. In order for a inpatient to receive Hospice services they must have a life expectancy of six months or less if the concluding illness or disease runs its normal course.

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Many habitancy mistakenly think that this means that the inpatient 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 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 inpatient may need to see a medical provider for something that is not connected to the concluding condition. For example, maybe the inpatient has low back pain and seeing a chiropractor gives the inpatient relief. Their concluding health is an inoperable brain tumor, or an inoperable aortic aneurysm. The back pain is not connected to the concluding condition. The inpatient receives relief from the chiropractic manipulation.

The chiropractor can still see the inpatient 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 assurance using the Gw modifier to indicate "service not connected to the hospice patient's concluding condition".

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

For me the question 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, anyone works.

Solutions medical Billing Inc

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