Wiki Resident modifiers


Charm City
Best answers
Looking for some clarification on using the resident modifiers. Do the GE/GC modifiers only go on E/M codes and procedures? What about ancillary services performed in office(u/a, venipunture, glucose, etc)? There seems to be differing views here in our office.

Thanks for any information!
Stacie Flagel, CPC
These are for E/M services only and are limited to the below circumstances (per CMS):

New Patient - 99201, 99202, and 99203
Established Patient - 99211, 99212, and 99213

Effective January 1, 2005, the following code is included under the primary care exception: G0344 - Initial preventive physical examination; face-to-face visit services limited to new beneficiary during the first 12 months of Medicare enrollment.

Effective January 1, 2011, the following codes are included under the primary care exception: HCPCS codes G0438 (Annual wellness visit, including personal preventive plan service, first visit) and G0439 (Annual wellness visit, including personal preventive plan service, subsequent visit).

If codes other than the ones listed above are billed with the GE modifier, the services will be returned as Unprocessable.
If a resident physician does not perform the service, the modifier is not needed. You mentioned U/A and lab tests. Those are never performed by a physician, so the the modifier would not apply to those services.

However, on radiology, anesthesia, medicine section codes, those are sometimes performed (in part) by a resident, in which case you would need to append the proper modifier.