Wiki How to Bill for a Resident as an Assistant Surgeon for a C-Section

Dcryts

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Hello,

Wondering if anyone has any input on this. How would you bill the resident charges if they were the assistant during a c-section and their supervising physician was the primary surgeon? The primary surgeon would be the billing provider on both claims which is not possible since the primary surgeon can't bill for both procedures. Is there a modifier that can be used since an attending physician was not available to be the assistant?

Any help is greatly appreciated!

Daryl
 
It's always been my understanding that you can't bill for a resident assisting at surgery because the payments to teaching programs already includes compensation for having residents perform this service. A provider can only bill and be paid for assisting at surgery in a teaching facility if a qualified resident is not available at the time of the procedure (and there is documentation to support this), in which case the provider who assists may bill and be paid using modifier 82.
 
Yes, exactly. The hospital gets funding to have a teaching program with residents. Except for specific E/M primary care services in specific geographic areas, residents are not billable.
You may want to consider -GC on your surgeon's claim. It is an informational modifier and does not impact payment.
GC: This service has been done in part by a resident under the direction of a teaching physician
 
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