DRG Coding Advisor: CMS clarifies billing for teaching physicians

The Centers for Medicare and Medicaid Services (CMS) has modified the Medicare Carriers Manual to clarify billing for certain teaching physician services that are exempted from the requirement that the physician be physically present during the key portions of the service (Transmittal Letter 1723).

To qualify for the exemption under the new standard, claims for services must contain the "GE" modifier in Item 24d of form HCFA-1500. Claims for services that require the presence of a teaching physician during the key portions of the service must contain the "GC" in Item 24d of the HCFA-1500 form.

Since 1996, the rule has been used for certain low-level evaluation and management services. Residents who met certain requirements could provide key portions of the service in the absence of the supervising teaching physician.