using the GC modifier with a "resident team"?

Got this issue today, never heard of this before...

If a resident or resident team is involved in the care you should assign the GC modifier to show participation in the residency teaching program. It does not matter if the resident wrote a note or if the teaching physician tied into the note. The teaching provider indicated that she discussed the case with the resident.

Thoughts?

Mary

Mary Flanery, CPC, CBCS, CHC
Quality Review Specialist
MedStar Physician Billing Services
Baltimore, Maryland 21220



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Comments

  • Oh my…that’s not good from my perspective. Modifier GC is to let the carrier know:


    1. A Resident was involved in providing the service

    2. A teaching physician was supervising the service and was personally involved in the service

    a. And that leads to the required teaching physician statement


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

    There is a primary care exception rule, but that’s using modifier GE.

    Kris

    Kris Cuddy, CPC, CIMC
    Healthcare Compliance Analyst
    Compliance Office
    Michigan State University HealthTeam
    East Lansing, MI
    Ofc: 517-355-4547
    Fax: 517-353-5292

  • edited May 2017
    We are a teaching facility – I use the GC modifier if a resident was present (and noted in the dictation). It is only a modifier recognized by Medicare, as we have gotten denials from other carriers with the use of the GC.



    Thanks

    Deborah Broyles, CPC
    Supervisor/Coding Specialist
    University Radiation Oncology/University Surgical Oncology
    865-305-9886 phone / 865-305-9714 Fax

  • So you believe that a resident does NOT have to document anything…

  • Thank you. I agree. But this has opened up an area that I never believed was “gray” until now.

    From: Kristine Cuddy [mailto:Kristine.Cuddy@hc.msu.edu]
    Sent: Monday, June 27, 2016 2:40 PM
    To: Multiple recipients of list PARTB-L
    Subject: RE:[partb-l] using the GC modifier with a "resident team"?

    Oh my…that’s not good from my perspective. Modifier GC is to let the carrier know:


    1. A Resident was involved in providing the service

    2. A teaching physician was supervising the service and was personally involved in the service

    a. And that leads to the required teaching physician statement


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

    There is a primary care exception rule, but that’s using modifier GE.

    Kris

    Kris Cuddy, CPC, CIMC
    Healthcare Compliance Analyst
    Compliance Office
    Michigan State University HealthTeam
    East Lansing, MI
    Ofc: 517-355-4547
    Fax: 517-353-5292

  • IMHO, the resident should be documenting something because they’re being taught, and this is regarding participation and supervision of a teaching physician, not just following a teaching physician around. They should also be signing the documentation.

    Kris

    Kris Cuddy, CPC, CIMC
    Healthcare Compliance Analyst
    Compliance Office
    Michigan State University HealthTeam
    East Lansing, MI
    Ofc: 517-355-4547
    Fax: 517-353-5292

  • Oops, this was meant to be a response to Mary Flannery’s email where she wrote:

    So you believe that a resident does NOT have to document anything…


    Kris

    Kris Cuddy, CPC, CIMC
    Healthcare Compliance Analyst
    Compliance Office
    Michigan State University HealthTeam
    East Lansing, MI
    Ofc: 517-355-4547
    Fax: 517-353-5292

  • Thanks everyone !!

  • edited May 2017
    My question would be why is she "discussing" the case with the resident?
    That seems to be the confusing point here.


  • It appears to be while rounding with their patients and training the residents. We have submitted this to our FI and will wait to hear their take. We are under Novitas.

    Thank you
  • edited May 2017
    That makes sense except for it would not be necessary to have it in the patient note.

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