using the GC modifier with a "resident team"?

mary.flanery@medstar.net

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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kristine.cuddy@hc.msu.edu

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

dbroyles@utmck.edu

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

mary.flanery@medstar.net

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

mary.flanery@medstar.net

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

kristine.cuddy@hc.msu.edu

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

kristine.cuddy@hc.msu.edu

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

mary.flanery@medstar.net

Thanks everyone !!

janrpcs@aol.com

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

mary.flanery@medstar.net

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

janrpcs@aol.com

That makes sense except for it would not be necessary to have it in the patient note.