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
Brooke Bierman, CPC, CPB
Coding & Billing Manager
2014 President AAPC Des Moines Chapter