Anesthesia Coding Alert

Question: What situations would call for use of the GC modifier? Are there any particular documentation requirements?

Minnesota Subscriber

Answer: To report the GC modifier (This service has been performed in part by a resident under the direction of a teaching physician) appropriately, the teaching anesthesiologist must be present during all key portions of the anesthesia service, and immediately available for the entire procedure. The teaching physician must document their participation and presence.

The GC modifier should not be used alone. It must be appended along with the appropriate medical direction modifier.

The Centers for Medicare & Medicaid Services (CMS) will reimburse the teaching anesthesiologist in the following situations:

1. The teaching anesthesiologist is training a resident in a single case.
2. The teaching anesthesiologist is directing two concurrent anesthesia cases involving residents.
3. A single case involving a resident when another concurrent case meets medical direction requirements.

For more information, check out these guidelines.

Julie McDaniel, MHA, CPC, CANPC, Contributing Writer