Outpatient Facility Coding Alert - 2016 Issue 1
Reader Question: No Hospice Employment Relationship? Use GV
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Article Overview
This reader question addresses how to report an emergency department encounter for a hospice patient when the treating physician is not employed by the hospice provider. It discusses general billing considerations for critical care, CPR, and hospice-related modifiers, along with a Medicare contractor perspective on when hospice-specific modifiers may apply. The article is useful for coders, billers, and revenue cycle staff who handle ED, hospice, and Medicare claims.
Why This Topic Matters
Hospice encounters can involve special modifier requirements and payer-specific rules that affect claim accuracy and payment. Understanding the scope of the services and the hospice relationship helps billing staff reduce denials and submit claims more appropriately.
Article Sections
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Question
Introduces the clinical setting, the services provided in the emergency department, and the coding uncertainty raised by the reader.
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Answer
Summarizes the recommended reporting approach and identifies the billing considerations discussed for the encounter.
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Explanation
Provides payer guidance and hospice-related context supporting the modifier discussion.
What You Will Learn
- How hospice-related billing considerations may affect an emergency department claim
- The general relationship between critical care, CPR, and modifier use
- Why payer guidance matters when hospice and non-hospice providers are involved
- What broad factors can influence billing for a patient with a DNR order
Who Should Read This
- Medical coders
- Billing specialists
- Revenue cycle staff
- Emergency department coders
- Hospice billing staff
Codes Discussed
Modifiers Discussed
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