Pulmonology Coding Alert

Question: Would you explain how I should use modifiers -GC and -GE when reporting services and procedures under the teaching-physician rules?

Alabama Subscriber

Answer: You should use modifier -GC (This service has been performed in part by a resident under the direction of a teaching physician) if the pulmonologist wants to bill for an E/M service that a resident helped perform (for example, 99203, Office or other outpatient visit ... new patient ...). Attaching this modifier lets the insurer know that you are reporting the E/M coding under the teaching-physician rules and using Medicare's documentation guidelines.
 
Typically, Medicare requires teaching physicians to provide direct supervision over a resident's procedures and services. But in primary-care offices, teaching physicians can sometimes get paid when a resident performs a low-level E/M without the physician present in the exam room. When you report a code under Medicare's primary-care exception rule, make sure to attach modifier -GE (This service has been performed by a resident without the presence of a teaching physician under the primary-care exception) to let the payer know why your physician didn't directly supervise the office visit. 
 
Remember that the primary-care exception does not apply to specialists, such a pulmonologists, but only to primary-care physicians like internists, who notify their local carrier, in writing, that they will be using the billing option. They must adhere to all of the restrictive requirements associated with this option.