From the Guidelines
There is no specific Diagnosis-Related Group (DRG) code for General Inpatient (GIP) hospice services. This is because hospice care, including GIP level of care, is not reimbursed through the DRG payment system. Instead, hospice services are paid under the Medicare Hospice Benefit using a per diem payment system with four different levels of care: Routine Home Care, Continuous Home Care, Inpatient Respite Care, and General Inpatient Care. Each of these levels has its own payment rate, but they are not assigned DRG codes. When a patient requires GIP hospice services for pain control or symptom management that cannot be provided in other settings, the hospice provider bills Medicare using the appropriate revenue code (0656 for GIP) rather than a DRG code. This distinction exists because DRGs are primarily used for acute care hospital inpatient stays under Medicare Part A, while hospice services operate under a separate payment methodology within the Medicare system, as noted in studies such as 1.
Some key points to consider include:
- Hospice care is defined as the support and care for patients and their families in the last phase of an incurable disease so that they may live as fully and comfortably as possible 1.
- The Medicare Hospice Benefit has specific requirements for eligibility, including a prognosis of six months or less and the patient's agreement to forego curative treatments 1.
- The payment system for hospice care is separate from the DRG payment system used for acute care hospital stays 1.
- The use of revenue codes, such as 0656 for GIP, is necessary for billing Medicare for hospice services 1.
In terms of the evidence, the most recent and highest quality study, 1, provides guidance on the payment system for hospice care and the use of revenue codes. This study, published in 2013, notes that the Medicare Hospice Benefit is a separate payment system that operates outside of the DRG payment system. Therefore, hospice providers should use the appropriate revenue code, rather than a DRG code, when billing Medicare for GIP hospice services.
From the Research
DRG Code for GIP Hospice Services
- The Diagnosis-Related Group (DRG) code for General Inpatient (GIP) hospice services is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, it is mentioned that GIP hospice care is a type of care provided to patients who require a higher level of care than what can be provided in a routine hospice setting 2, 3, 5.
- The studies focus on the utilization of GIP hospice services, factors associated with its use, and the impact of the COVID-19 pandemic on its utilization 2, 3, 5.
- One study discusses the coding and reimbursement mechanisms for physician services in hospice and palliative care, but does not provide a specific DRG code for GIP hospice services 6.
- Therefore, based on the provided evidence, there is no clear answer to the question of what the DRG code for GIP hospice services is.