Wiki Modifier GC

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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!!
 
mitchellde said:
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.
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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
 
vidraj said:
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
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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.

 
csperoni said:
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.

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Thank you. very helpful details:)
 
igrigoras@iowaclinic.com said:
What about surgeries, procedure - do they need to document what the resident did during the surgeries/help with etc. or listed the resident as an assistant is sufficient? Thank you in advance.
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When a resident is present, there are 2-3 scenarios. 1) they performed the surgery under the guidance of the teaching physician 2) they acted as assistant only 3) they observed only. If the resident performed, there must be a statement that the teaching physican was present for the entire procedure. Anytime there is an assistant, the tasks they assisted with should be documented in the note, whether or not it was a resident. To bill for an assistant charge in a teaching facility by a fully qualified MD/APP - the note must state why a resident wasn't used. If they are only observing, that should be stated as well.
 
Cmama12 said:
When a resident is present, there are 2-3 scenarios. 1) they performed the surgery under the guidance of the teaching physician 2) they acted as assistant only 3) they observed only. If the resident performed, there must be a statement that the teaching physican was present for the entire procedure. Anytime there is an assistant, the tasks they assisted with should be documented in the note, whether or not it was a resident. To bill for an assistant charge in a teaching facility by a fully qualified MD/APP - the note must state why a resident wasn't used. If they are only observing, that should be stated as well.
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Thank you!
 
Cmama12 said:
When a resident is present, there are 2-3 scenarios. 1) they performed the surgery under the guidance of the teaching physician 2) they acted as assistant only 3) they observed only. If the resident performed, there must be a statement that the teaching physican was present for the entire procedure. Anytime there is an assistant, the tasks they assisted with should be documented in the note, whether or not it was a resident. To bill for an assistant charge in a teaching facility by a fully qualified MD/APP - the note must state why a resident wasn't used. If they are only observing, that should be stated as well.
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I have a question regarding the scenario where the resident was the assistant. In my case the teaching physician, who is the surgeon, dictated the entire operative report. In one case the TP did state what the assistant surgeon helped with but he did not add a resident attestation and we were told we should not have used the GC modifier. We were also told that the resident should add a statement as to what they assisted with during the surgery in addition to needing the TP resident attestation. Do we actually have to get all that documented in the op note? The other example the provider again dictated the operative note and listed the resident as the assistant but didn't state what the assistant helped with during the procedure. I know we need the provider to add what the resident assisted with, but do we have to get all these additional statements from the resident? I could understand if the surgeon acted as a co surgeon or did portions of the procedure themselves. We have to get the resident to write out they sutured something or helped pull the baby out during a c-section?
 
In general, the resident will always be listed as the assistant, so it can be confusing (as in both examples below). Assistant tasks should always be documented as a general rule, whether or not a resident was present.

In my organization, if the TP dicated the note and resident is listed as assistant, then TP performed it and no GC modifier or statements would be applicable. (see second note below).

If the resident dictated and signed, then they performed and a teaching attestation and modifier GC is required. If, as in the below case, a fully qualfied MD assisted, there needs to be a statement about why a resident was not used. So in the below case, we would have 58571-GC billing under TP and 58571-82, under the MD assistant.

Prior Versions:1. Teaching Physician, MD (Physician) at 2/26/2025 1:40 PM - Incomplete Revision
2. Resident 1, DO (Resident) at 2/26/2025 1:35 PM - Cosign Needed
Operative Procedure Note
2/26/2025, 7:15 AM

Procedure: Procedure(s):
ROBOT-ASSISTED, TOTAL LAPAROSCOPIC HYSTERECTOMY, BILATERAL SALPINGO-OOPHORECTOMY, CYSTOSCOPY

Surgeon:
Teaching Physician, MD
other physician, DO - I certify that the assistant surgeon services were medically necessary. A qualified resident was not available to perform the services given the complexity of the case.

Assistant(s):
Resident 1, DO PGY-3
Resident 2, DO PGY-2
Student, MS2

Assistant Tasks: Opening and closing, Dissecting tissue, Removing tissue, and Altering tissue


(Bottom of note)
Teaching Physician, MD was present and scrubbed throughout the entire procedure.

Resident 1, DO PGY-3
Obstetrics & Gynecology
02/26/25

Attending Note:

I was present and scrubbed for the entire procedure. I have reviewed and edited where needed, the above resident note, and agree with findings.

Teaching Physician, MD
Obstetrics & Gynecology





Resident assist only - note created by MD, no resident signature


Signed xxxxx, MD (Physician)


OPERATIVE REPORT

PROCEDURE DATE: 2/21/2025

PREOPERATIVE DIAGNOSIS:
IUP at 16w1d by dates
Missed abortion measuring 11wks

POSTOPERATIVE DIAGNOSIS:
Status post dilation and curettage

PROCEDURE: Dilation and curettage under ultrasound guidance

PROCEDURE PERFORMED BY: xxxx, MD

ASSISTANT(S): xxxx, MD PGY4
 
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Cmama12 said:
In general, the resident will always be listed as the assistant, so it can be confusing (as in both examples below). Assistant tasks should always be documented as a general rule, whether or not a resident was present.

In my organization, if the TP dicated the note and resident is listed as assistant, then TP performed it and no GC modifier or statements would be applicable. (see second note below).

If the resident dictated and signed, then they performed and a teaching attestation and modifier GC is required. If, as in the below case, a fully qualfied MD assisted, there needs to be a statement about why a resident was not used. So in the below case, we would have 58571-GC billing under TP and 58571-82, under the MD assistant.

Prior Versions:1. Teaching Physician, MD (Physician) at 2/26/2025 1:40 PM - Incomplete Revision
2. Resident 1, DO (Resident) at 2/26/2025 1:35 PM - Cosign Needed
Operative Procedure Note
2/26/2025, 7:15 AM

Procedure: Procedure(s):
ROBOT-ASSISTED, TOTAL LAPAROSCOPIC HYSTERECTOMY, BILATERAL SALPINGO-OOPHORECTOMY, CYSTOSCOPY

Surgeon:
Teaching Physician, MD
other physician, DO - I certify that the assistant surgeon services were medically necessary. A qualified resident was not available to perform the services given the complexity of the case.

Assistant(s):
Resident 1, DO PGY-3
Resident 2, DO PGY-2
Student, MS2

Assistant Tasks: Opening and closing, Dissecting tissue, Removing tissue, and Altering tissue


(Bottom of note)
Teaching Physician, MD was present and scrubbed throughout the entire procedure.

Resident 1, DO PGY-3
Obstetrics & Gynecology
02/26/25

Attending Note:

I was present and scrubbed for the entire procedure. I have reviewed and edited where needed, the above resident note, and agree with findings.

Teaching Physician, MD
Obstetrics & Gynecology





Resident assist only - note created by MD, no resident signature


Signed xxxxx, MD (Physician)


OPERATIVE REPORT

PROCEDURE DATE: 2/21/2025

PREOPERATIVE DIAGNOSIS:
IUP at 16w1d by dates
Missed abortion measuring 11wks

POSTOPERATIVE DIAGNOSIS:
Status post dilation and curettage

PROCEDURE: Dilation and curettage under ultrasound guidance

PROCEDURE PERFORMED BY: xxxx, MD

ASSISTANT(S): xxxx, MD PGY4
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Thank you so much!
 
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