Wiki resident supervision with GC and GE modifier

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salinafoster

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I code physician services for a hospital that has an internal medicine and surgical residency program, the company I work for was instructed by hospital administration not to use the GC modifier with the logic that the hospital has an outpatient clinic GME program therefore all In patient services are exempt from reporting the GC modifier. My understanding is that any service done by a resident under supervision needs the GC modifier and GME programs only cover low level outpatient EM's when done by a resident without direct supervision but still require modifier GE. Guidelines from CMS have been presented to the hospital administrator and she is admit that reporting supervised resident services with GC modifier is incorrect, that no modifier is needed can anyone advise?
 
Hmmm

I've been coding for a Family Medicine Residency for 10 years and I've never heard of such a thing when it comes to Medicare claims. All resident visits must have GE or GC.
 
Gc/ge

I code for a Family Medicine Residency Program. We have an outside clinic and I use the GC/GE modifier on claims.
I also use on nursing home claims. I use it when I bill out the resident with an Attending.
When I bill out hospital claims no Resident is indicated other than the note.
My understanding is the notes are combined if the modifier is there if not only the Attending notes will be used for claim.
Which with my physicians would not be enough for a 221 or 231.
 
GE Modifier

When the GE modifier is used does a Supervisor have to be in the building or can he review and sign off on a PG3 note?
 
Teaching physician guidelines

"When the GE modifier is used does a Supervisor have to be in the building or can he review and sign off on a PG3 note?"

for Medicare, in the building is my understanding and this is only for 99201-99203, 99212-99213. Any and ALL other levels of service must be physically staffed. So all hospital visits and level 4-5's in the office.


https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf

Teaching physicians submitting claims under this exception may not supervise more than four residents at any given time and must direct the care from such proximity as to constitute immediate availability. Teaching physicians may include residents with less than 6 months in a GME approved residency program in the mix of four residents under the teaching physician’s supervision. However, the teaching physician must be physically present for the critical or key portions of services furnished by the residents with less than 6 months in a GME approved residency program. That is, the primary care
exception does not apply in the case of residents with less than 6 months in a GME approved residency program.

Teaching physicians submitting claims under this exception must:
• Not have other responsibilities (including the supervision of other personnel) at
the time the service was provided by the resident;
• Have the primary medical responsibility for patients cared for by the residents;
• Ensure that the care provided was reasonable and necessary;
• Review the care provided by the resident during or immediately after each visit.
This must include a review of the patient’s medical history, the resident’s findings
on physical examination, the patient’s diagnosis, and treatment plan (i.e., record
of tests and therapies); and
• Document the extent of his/her own participation in the review and direction of
the services furnished to each patient.


Hope this helps!
Chris
 
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