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How to code for care of hospice patients, for e-prescribing and for test results


Various areas of coding, including hospice patients, e-prescribing and tuberculosis test results, are addressed

Key Points

A: Two types of modifiers are used when billing for services rendered to hospice patients.

The first is the GW modifier, for providers who are rendering care unrelated to the patient's terminal illness. If you have provided an evaluation and management (E/M) service and a procedure to the patient on the same day and need to append the E/M service with the modifier –25, it should be listed first, with the GW modifier listed second. Use of the GW modifier notifies Medicare that the service you provided was unrelated to the illness and will ensure that your claim gets paid.


Q: For the Physician Quality Reporting Initiative, we are reporting the G codes for e-prescribing, but we do a lot of prescription refills, for which we also use e-prescribing when the patient is not seen. Can I submit the G code without another service when we refill prescriptions because we do so many of them?

A: Submitting quality measures requires a qualifying service-an E/M service or procedure (denominator). Each measure has a list of qualifying Healthcare Common Procedure Coding System codes, including those for e-prescribing.

The G code you report, G8443 (used qualified e-prescribing system for all prescriptions), G8445 (had qualified e-prescribing system but generated no prescriptions during this encounter), or G8446 (had qualified e-prescribing system but prescribed narcotics during this encounter; state or federal law required phone in or printed prescriptions; patient requested phone in or printed prescription; pharmacy system can't receive electronic transmissions) requires the reporting of a service. A list of those services can by found on the Centers for Medicare and Medicaid Services Web site, by quality measure.


Q: We administer a significant number of tuberculosis tests, requiring the patient to return in several days to have the test read. These visits necessitate pulling the chart again and using our clinical staff time to examine the patient. Is it permissible to charge a nurse visit 99211 to read the test?

A: Interpretation of the test result is part of the test and, as such, is not a separately billable service. Unless a separately identifiable E/M service occurs on the day the patient returns (for instance, the patient came down with a cold and is requesting that the nurse listen to his chest and that a prescription be called in; or the patient had an episode of vertigo since he was in last and is requesting that his blood pressure be checked and/or his hypertensive medications be adjusted), it is inappropriate to charge for the visit.

Medical Economics Consultant Virginia Martin, vice president of operations for Reed Medical Systems in Monroe, Michigan, has more than 30 years of experience as a practice management consultant and also is a certified coding specialist, certified compliance officer, and certified medical assistant. Have a coding or managed care question for our experts? Send it to meletters@advanstar.com

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