“I did a house call yesterday on a patient under at-home hospice care. She had a diabetic wound on the foot that I provided care for. I also did “At Risk,” Routine Foot Care as she has Q7 findings. She has Aetna Advantra Medicare Advantage Plan. I have a couple of questions.
1. Does the house call visit get billed to Medicare or to Aetna Advantra? I will use the "G" modifiers indicating this is separate from her hospice condition.
2. Am I permitted to perform wound care / debridement services on a hospice patient with Aetna Advantra or traditional Medicare, or does this fall back on the hospice doctor/nurses to manage, while I stick to the nail care? I just want to make sure I am reimbursed for this care, as knowing she has a wound will require more frequent home visits to manage it. If not, I need to make sure to coordinate care with the hospice physician going forward (The patient is able to make decisions and wants the wound care performed).
So, a patient in hospice care at home was treated by a DPM for a diabetic wound and for "At Risk," Routine Foot Care. The patient is insured with Aetna Advantra Medicare Advantage Plan.
Question #1: When a patient goes into hospice, they are no longer covered by the Medicare Advantage Plan. They are now covered by Traditional Medicare and that is the health insurance carrier that is now billed. Whether it is an E/M service or a CPT/procedure code that is billed, all services that are provided and billed for are appended by the appropriate "G" modifier. If the service(s) being provided is/are NOT related to the hospice patient's terminal condition, the GW modifier would be appended to each of the CPT codes that are billed. The GW modifier is defined as the following: 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.
Question #2: I am assuming that the ulcer/wound that the patient has is NOT related to the patient's terminal condition. If that is indeed the case, the DPM is able to follow up and treat the patient at his/her home the same as if the patient was not in hospice and needed the same care for the ulcer/wound. As I stated in response to question #1, all services provided would be billed to the Traditional Medicare Administrative Contractor and would be appended by the GW modifier.
Of course, the coding/billing sequence would be the same appended by the appropriate modifiers as it would be if the patient was not in hospice care at home.
This is my opinion.
Michael G. Warshaw, DPM, CPC
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