Surgical Dressings Billed with GW Modifier Pre-Pay Review Quarterly Status Report
Below is the analysis of claim denials for GW modifier surgical dressings HCPCS codes A4452, A6213, A6219, A6222 and A6446 reviewed between October 1 and December 31, 2023. The error rate for this quarter is 100%. The top 3 reasons for claim denials are as follows:
Rank | Reason | Percent |
---|---|---|
1. | Invalid use of GW modifier. | 81.82% |
2. | Payment for supplies billed above normal policy usage is being denied due to lack of documentation to support that they are reasonable and necessary. | 9.09% |
3. | The claim submitted is a duplicate to another claim billed. | 9.09% |
*The total percentage will be greater than 100% because some claims were denied for multiple reasons.
**The error rate included is an overall average for the supplier specific reviews as a part of the Targeted Probe and Educate program. This is not meant to represent an overall error rate for the HCPCS code or policy under medical record review.
Resources:
- GW Modifier Usage for Hospice Patients
- Hospice and GW Modifier Prepayment Reviews
- Medicare Minute ℠ Hospice and GW Modifier
- Surgical Dressings Documentation Checklist
- Surgical Dressings – LCD (L33831)
- Surgical Dressings – Policy Article (A54563)
Updated: February 2, 2024