Wiki Modifier GC

jknudsen7

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I work for a hospitalist group and our physicians are contracted at a teaching hospital. We were only recently made aware of modifier GC. We have not been using this on our charges when supervising residents and we are getting paid with no issues. My question is, if we start using this, is it going to prompt an audit? Would we be ok to continue NOT using this modifier? We have been involved in audits in the past where we were required to send notes on these types of charges and there were no issues. We want to do what is right, but don't want to invite unnecessary attention. Thoughts?
 
If a resident provided the service and the supervising provider provided the attestation indicating he/she also saw and evaluated the patient then yes you are to use the GC modifier. If there is no attestation or the supervising provider does not indicated they saw the patient but only read and approved the documented the visit is not billable. So the use of the GC modifier is the assurance that the qualification for a billable service when provided by a resident has been met.
 
I am struggling with whether the -GC for the E/M goes on the -PC charge, the -TC charge, or both.

Example:
E/M provided by resident under supervision. Documentation contains attestation. Rapid strep performed, so modifier -25 needed, as well.

Which is correct:

ABC
99214-PC -GC
99214-PC
99214-PC -GC
G0463-TC -25
G0463-TC -25 -GC
G0463-TC -25 -GC
87880-TC
87880-TC
87880-TC

Or something else??

Thank you!!
 
If a resident provided the service and the supervising provider provided the attestation indicating he/she also saw and evaluated the patient then yes you are to use the GC modifier. If there is no attestation or the supervising provider does not indicated they saw the patient but only read and approved the documented the visit is not billable. So the use of the GC modifier is the assurance that the qualification for a billable service when provided by a resident has been met.
Hi,

I am a newbie for the teaching facility coding and need some help.

Our surgeon is an attending physician for a teaching hospital, and I see a variation in the inpatient follow-up notes.

1. The visit note is written by the resident and has a the PGY1-4 verify/add an addendum on updated findings/treatment plan if any - which is cosigned by our surgeon.

2. Others the visit note is written by the resident, or the PGY1-4 and our surgeon make a separate note himself on the findings/treatment plans of that encounter.

My questions are:
Can I bill both the visits under our surgeon?
Should I use GC modifier for both these visits? (Or all follow-up visits cosigned by our surgeon)

Any help is appreciated. TIA
 
Hi,

I am a newbie for the teaching facility coding and need some help.

Our surgeon is an attending physician for a teaching hospital, and I see a variation in the inpatient follow-up notes.

1. The visit note is written by the resident and has a the PGY1-4 verify/add an addendum on updated findings/treatment plan if any - which is cosigned by our surgeon.

2. Others the visit note is written by the resident, or the PGY1-4 and our surgeon make a separate note himself on the findings/treatment plans of that encounter.

My questions are:
Can I bill both the visits under our surgeon?
Should I use GC modifier for both these visits? (Or all follow-up visits cosigned by our surgeon)

Any help is appreciated. TIA
In order for your surgeon to submit an E&M charge, your surgeon must have provided an E&M charge. Co-signing a note is NOT sufficient. Your MD must have at least been present (or saw the patient later in the day) and participated in the management (excluding approved primary care exception locations.) Any hospital EMR system I have used contained a macro for an attestation. Something like:
“I was present with resident during the history and exam. I discussed the case with the resident and agree with the findings and plan as documented in the resident’s note.”
“I saw and evaluated the patient. I reviewed the resident’s note and agree with findings and plan as documented in the resident’s note.”
or whatever other wording that states YOUR physician was physically present and/or personally evaluated the patient and participated in management.

There are currently still some exceptions for the PHE, but that is expiring anyway, and was intended to be used during the actual emergency situation, so not even delving into that here.

 
In order for your surgeon to submit an E&M charge, your surgeon must have provided an E&M charge. Co-signing a note is NOT sufficient. Your MD must have at least been present (or saw the patient later in the day) and participated in the management (excluding approved primary care exception locations.) Any hospital EMR system I have used contained a macro for an attestation. Something like:
“I was present with resident during the history and exam. I discussed the case with the resident and agree with the findings and plan as documented in the resident’s note.”
“I saw and evaluated the patient. I reviewed the resident’s note and agree with findings and plan as documented in the resident’s note.”
or whatever other wording that states YOUR physician was physically present and/or personally evaluated the patient and participated in management.

There are currently still some exceptions for the PHE, but that is expiring anyway, and was intended to be used during the actual emergency situation, so not even delving into that here.

Thank you. very helpful details:)
 
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