Managing a patient's critical illness with CCM codes 99437-99427 is used to prevent further life-threatening deterioration. Therefore, these codes may not apply to this type of service. CMS does state in rare occasions; critical care services may be used. For example, if there is an unexpected and acute emergency, it may be permissible. In this case, medical records would be required.
Primary Care Physician and Hospice
Generally, the primary care is the attending physician (although not a PA or NP). Suppose the patient wants to maintain care from their Primary Care Physician; if the physician is not employed by hospice, the MD or DO can bill Medicare Part B for their services. In this case, they would be responsible for providing actual hospice care, such as writing orders, working with the hospice team, and giving direction for the patient's care.
If the patient does not have an attending, they can choose either a physician or a nurse practitioner that Is employed by hospice. The patient must be provided with a choice of being attended by a physician or a nurse practitioner.
Specialty PhysicianIf a specialty physician is required to treat another condition, they would need to contract with hospice for the care of the patient to receive reimbursement, as Medicare will not pay them directly; they will pay hospice.
Required modifiers should be used accordingly.
If the provider provides a service related to the hospice diagnosis, the GV modifier is required.
If the provider provides a service that is NOT related to the hospice diagnosis, the GW Modifier is required.
GW modifier (service not related to the hospice patient's terminal condition).
GV - Attending physician not employed or paid under arrangement by the patient's hospice provide