“I often provide wound care for hospice patients and append the GW modifier. However, I recently read that it would be hard to defend this as the wound(s) and wound process is likely related to the patient being deconditioned and malnourished due to their hospice qualifying condition. I am looking for clarification regarding this, should I stop performing wound care services to hospice patients?”
This is somewhat of a bizarre scenario. With very few exceptions, if a patient is seen in hospice for a condition or for care that is clearly NOT related to the patient’s hospice condition, it is appropriate to append the GW modifier to the E/M service and/or CPT procedure code that was performed.
The GW modifier is defined as: HOSPICE SERVICES – Use this Medicare modifier when you need to indicate that the provided services are not related to the hospice patient’s terminal condition.
So, the physician in the post is providing wound care to a patient in hospice who I am sure is bedridden due to the medical condition that required hospice care in the first place. You would think that the GW modifier would be appropriate. However, the physician is now being told that “DUE TO THE HOSPICE QUALIFYING CONDITION, the wounds are related to the patient being deconditioned and malnourished due to their hospice qualifying condition.”
If this is the position that is being taken by Medicare, I would submit a corrected claim. I would not append the GW modifier. I would append the GV modifier. The GV modifier is defined as: HOSPICE SERVICES – Use this Medicare modifier if providing services that are not provided under a payment arrangement with a Hospice. Services furnished for treatment and management of Hospice patient’s terminal condition.
This is my opinion.
Michael G. Warshaw
DPM, CPC
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