Wiki GC and GE modifiers help please

[yvettebook]

Pediatric patient, charged an e/m 99213 for both facility and pro fee; seen in full by resident and then just discussed with attending per her attestation.
Would you report 2 E/M visits and append GE on the pro fee e/m?

I have reviewed CMS guidelines and Coding Clinic 4th qtr 2013 but I am really confused when it would be appropriate to append GE/GC modifiers.
For example, if the peds clinic is owned by a teaching hospital - would these modifiers apply?
What are the teaching-physician rules, according to the Medicare Carrier Manual as it states that teaching physician (TP) that supervises a resident service in a clinic will use this.
Than you so much in advance!!!

 

[Chelle-Lynn]

GC indicates that the resident performed the service in the presence of the attending. In this case it sounds like your resident rendered services under the Primary Care Exception Rule. Meaning that the services level was a 3 or lower (99203 or 99213 or lower) and that the resident saw the patient on their own and reported their findings to the attending who agreed and signed off. (Note: see requirements for Primary Care Exception Rule for a full understanding).

In this case you would bill the service under one E&M code for the resident services only with the modifier GE. The attendings time is not taken into consideration when in a teaching setting.