UCR 228: G0559 clarification, GC Modifier Explained, and G2211 documentation suggestion.

January 24, 2025

Scott, Mark, and Dr. Ray Painter address questions submitted to the PRS Network.

1. I recently attended your Billing and Coding conference in Las Vegas this past December.
   I need clarification on New CPT code G0559, can someone please contact me as soon as possible.
2. From a coding perspective, I have a question regarding the GC modifier for a teaching facility. Also, is there a difference between the coding perspective and the compliance side of the question?
   How crucial is adding the modifier GC to the encounter when a patient is seen by both the Resident and the Faculty member?
3. Appreciate any insight y'all can provide.
4. My coder is requiring me to add a statement for G2211 codes.
5. "E and M visit today is associated with current or anticipated ongoing medical care services related to a patient's single serious condition or complex condition."
   
   Is this necessary? Reading the CMS guidelines they say no. They are worried about "Bulletproof" Documentation. I am coding these with many of my follow up patient who have chronic BPH, OAB, ED and cancer. Thoughts on how to respond to them?

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