GC modifier in ED

welzi

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I have been told GC modifier is E&M modifier only? I have found indications that it may also be coded w/procedures? Can someone please clarify for me? (This is for Teaching Hosp ER) Ex: if wound lac is repaired--does GC modifier go on E&M & Wound repair? welzi
 
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BABS37

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The GC modifier is reported by the teaching physician to indicate he/she rendered the
service in compliance with the teaching physician requirements by Medicare and I listed those below. Never heard of billing the GC with anesthesia codes...only used with E/M. Also, an attestation must be documented in order to bill it.

For purposes of payment, E/M services billed by teaching physicians require that they
personally document at least the following:
That they performed the service or were physically present during the key or
critical portions of the service when performed by the resident; and
The participation of the teaching physician in the management of the patient.
When assigning codes to services billed by teaching physicians, reviewers will combine
the documentation of both the resident and the teaching physician.
Documentation by the resident of the presence and participation of the teaching physician
is not sufficient to establish the presence and participation of the teaching physician.
On medical review, the combined entries into the medical record by the teaching
physician and the resident constitute the documentation for the service and together must
support the medical necessity of the service.

The teaching physician must document that he/she personally saw the patient and
participated in the management of the patient. The teaching physician may
reference the resident's note in lieu of re-documenting the history of present
illness, exam, medical decision-making, review of systems and/or past
family/social history provided that the patient's condition has not changed, and the
teaching physician agrees with the resident's note.
The teaching physician's note must reflect changes in the patient's condition and
clinical course that require that the resident's note be amended with further
information to address the patient‟s condition and course at the time the patient is
seen personally by the teaching physician.
The teaching physician‟s bill must reflect the date of service he/she saw the
patient and his/her personal work of obtaining a history, performing a physical,
and participating in medical decision-making regardless of whether the
combination of the teaching physician‟s and resident‟s documentation satisfies
criteria for a higher level of service. For payment, the composite of the teaching
physician‟s entry and the resident‟s entry together must support the medical
necessity of the billed service and the level of the service billed by the teaching
physician.
 

cblack712

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I have worked many aspects of teaching hospitals (ER, Rad, OB) and for EVERY service that a Physician overseas a Resident you will bill the CPT with a GC modifier. Whether it be E/M, Anes, OB, Rad, Cardio - doesn't matter! If you have an E&M and wound care and both are done by the resident and overseen by the Physician and the physician notes that he oversaw the residents care of said patient both the E/M and Wound Care cpt would have the GC modifier.
Go to this link (its the cms manual) and section 100 details the rules and regs and it does include E/M, Surgeries, and Anesthesia
http://www.cms.gov/manuals/downloads/clm104c12.pdf
 

limpson

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I concur with cblack712.

The ones we usually deal with (ED pro fee only) are related to E/M, diagnostic (usually EKG - 93010), and therapeutic services (chest tubes, intubation, wound repair, etc.). Each of these types of services have different Teaching Physician attestation requirements.

Larry
Compliance Officer
Synergistic Systems LLC
 

LLovett

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babierman, maybe you should re-read the orginial question and your answer.

The question was can GC be used with procedures or just E/M. The answer you gave was just E/M.

The modifier is appropriate for procedures as well as E/M if you meet the requirements.

This modifier is for Medicare and Medicaid. You may have issues with commercial carriers accepting it.

Laura, CPC, CPMA, CEMC
 

BABS37

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Yep, I re-read both and I understand it and I know residents get credit for all services they did when documented but I guess that means all five of the ED coders have been doing this wrong because we hand write out our ED's and hand them off and we only put the GC on the E/M side. None of us put the GC on any other codes we billed for with the residents. Guess thats how people interpret questions differently when asked depending on how the facility you work for does things. Guess that just means we're doing it wrong and some changes need to be implemented.
 
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Critical Care 99291 99292

Can the GC modifier be used on critical care codes in the hospital setting? (in patient). I have been coding it if the documentation meets the requirements. I was told it can not be used in the hospital setting. Thanks!
 
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