General Surgery Coding Alert

Question: Our surgeon sometimes has a resident assist in surgery at a teaching hospital. Should we use modifier GC with the surgical code, or is that modifier only for E/M services?

Georgia Subscriber

Answer: Modifier GC (This service has been performed in part by a resident under the direction of a teaching physician) is viable for surgical codes as well as E/M codes, when appropriate.

That means you should append modifier GC to the surgical procedure code when a resident assists your surgeon in a teaching hospital.

Learn TP rules: When your surgeon works as a “teaching physician” (TP) and supervises a resident’s services in a clinic or hospital setting, you will have to report your physician’s work using the TP rules, according to the Medicare Carriers Manual section 15016.

The MCM defines a resident as an intern or fellow who’s enrolled in an accredited graduate medical education (GME) program.

For your surgeon to bill a surgical code with modifier GC, you should make sure the surgeon documents that he functioned as a TP. That means the TP was present for the entire procedure, or present for the key and/or critical portions of the procedure and immediately available for the rest of the procedure (such as present in the operating suite).

Bottom line: Use modifier GC when you have documentation that your surgeon functioned as a TP for a resident for both E/M and surgical procedures.