Wiki AS & GC Modifier

[Jennifer Turner]

Hello,

We currently have a fellow and I am wanting to know if we are able to bill the AS & GC modifier together, when the MD, Fellow, & PA are all in Surgery together. Any insight is greatly appreciated!

 

[csperoni]

You cannot bill for the fellow in an approved GME program. Modifier -GC (which is only for Medicare to my understanding) is an informational code only and does not affect payment. It would be attached to the teaching physician's claim in the situation that the fellow performed part of the surgery (cannot be a "key" portion unless the teaching surgeon is physically present).
If the scenario was:
Teaching surgeon opened patient, performed the surgery, then fellow closed (with or without surgeon present) and your PA assisted, bill
12345-GC for teaching surgeon
12345-AS for PA assist
If your teaching surgeon was primary for everything and fellow was first assist, with PA 2nd assisting, bill
12345 (no modifier) for surgeon
nothing for the assist since you cannot bill for the fellow and your PA was only 2nd assist

Reference CMS Pub 100-04 section 100.1.2 for surgeries.
https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R2303CP.pdf

 

[Jennifer Turner]

Thank you so much for providing insight on this. You completely spelled it out to me very clear and along with providing me with a reference to back it up. Thank you so much!