Pain Management Coding Alert

Published on Mon Nov 03, 2014 PDF

Question: When a resident assists a physician in a teaching hospital, do we need to add modifier GC to the procedure code for surgery or is that a modifier for E/M codes only?

Florida Subscriber 

Answer: Yes, you should append modifier GC (This service has been performed in part by a resident under the direction of a teaching physician) to surgical procedure codes when a resident assists a surgeon in a teaching hospital. 

Modifier GC is not only for E/M codes. The modifier indicates that a resident provided the procedure under a teaching physician’s direction.

Know TP rules: When your surgeon works as a “teaching physician” (TP) and supervises a resident’s services in a clinic or hospital setting, you will have to report your physician’s work using the TP rules, according to the Medicare Carriers Manual (MCM), section 15016.

The MCM defines a resident as an intern or fellow who’s enrolled in an accredited graduate medical education (GME) program.

When you report surgeries, you should make sure the surgeon documents that he functioned as a TP. That means the TP was present for the entire procedure — or present for the key and/or critical portions of the procedure and immediately available for the rest of the procedure (such as present in the operating suite). 

Bottom line: Use modifier GC when you have documentation that your surgeon functioned as a TP for a resident for both E/M and surgical procedures.