GV-vs-GW-Modifiers

GV and GW Modifiers for 2022 & 2023: A Comprehensive Guide

Codes and modifiers simplify the billing and coding process and help medical providers at every level. In addition, GW and GV are HCPCS Level II Medicare Hospice Modifiers. You Need to know everything regarding GV and GW modifiers. Read the whole article to know what they are and what defines them.

What Does Hospice Mean, And How Is It Related to GV vs GW Modifier?

Hospice is a special care that focuses on the quality of life for people who are going through life-limiting illnesses. It’s a space where supportive care is delivered to seriously ill patients. To have the reimbursement for the services provided to these ill patients at the Hospice healthcare center, the providers should bill the hospice contactor.

Moreover, if the physician attending to the patient is not a part of an employee under the Hospice tag but performs the healthcare services to the patient, and if the patient is admitted to Hospice healthcare, then the reimbursement claims for all those services will be submitted to Medicare. These claims will be getting ready along with the GW and GV modifiers by making sure, that separate payments will be made.

How Does Medicare process the GV and GW modifiers?

GV Modifier 

When a patient is treated for a diagnosis associated with hospice care, but the physician participating in the patient’s treatment is not compensated by or employed by Hospice, a GV modifier is added to the claims.

That means if the patient is admitted to Hospice and the physician attending the patient is not an employee of the Hospice, then they will be get paid through Medicare for the services related to the Hospice even if they are not an employee of the Hospice. Also, it is very important to add the GV modifier to make the proper reimbursement on time.

Here are some points to keep in mind:

  • Only non-Hospice physicians will benefit from adding a GV modifier to claims. The Hospice contractor should receive claims from doctors who work for Hospice.
  • If the physician treating the patient in the hospice facility is not known as the hospice employer, do not add the GV modifier to the claims.
  • Even if the attending physician is not a Hospice employee, adding a GV modifier from the Hospice contractor will only be possible if the patient is qualified for the Hospice programs and plans.

Let’s see one example to learn about the GV modifier more

Let’s suppose the patient is enrolled in the Hospice for pulmonary disease treatment. On his visit, he goes to a physician not associated with treating pulmonary disease as a hospice entity.

In this case, the procedure was carried out for the sickness in question by a doctor not associated with Hospice. As a result, the claim will be submitted to Medicare with reported GV modifiers.

Modifier GW

GW modifier is used in the claims when the patient’s diagnosis is not concerned with Hospice diagnosis performed by a physician who is not an employee or paid by the Hospice.

That means when the patient is admitted to the Hospice, the physician who is attending to the patient is not associated with Hospice and the services provided to the patient are not related to the initial major issue. The provider must use the GW modifier to the CPT-10 code while they submit their claims to Medicare.

Essential Guidelines To Remember:

  • Physicians serving as healthcare professionals for Hospice for a specific ailment will not have GW modifiers added. Their claims would be sent to hospice contractors because Medicare standards can only read GW modifications to ICD-10 numbers.
  • GW modifications will not be applied if a doctor is not listed as the patient’s attending doctor.
  • When the beneficiary is a Hospice program participant and the doctor providing them with treatment is not employed for the patient’s condition, appending GW modifications would be advantageous to the doctors.

 

Example 

When Hospice does not compensate the attending physician as a Hospice entity under debridement of the nail, a patient in Hospice visits the doctor for heart failure congestion.

In this case, the doctor’s procedure had nothing to do with their training in hospice care. Therefore, providers must pair the CPT- 11720 (nail debridement) code with GW modifiers while submitting claims.

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