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Payment For Teaching Physician Services Requires Careful Documentation

Coding Corner

The information provided here applies to Medicare coding. Be sure to check with your Medicare Administrative Contractor (MAC) for additional information and clarification on these and other items. You should also contact your local insurance carriers to determine if private insurers follow Medicare's lead on all coding matters.

Payment For Teaching Physician Services Requires Careful Documentation
The guidelines for billing as a teaching physician are often very confusing. Here are some of the more important requirements to remember. First, the trainee must be in an accredited graduate medical education program. The teaching physician may use the documentation of the trainee to document the level of code being applied; however, the teaching physician must refer to the resident, intern, or students notes and state that this documentation was reviewed. You need to state whether you agree with the diagnosis, and any additions to, or subtractions from, the note also must be documented.

The resident, student or intern should be present for these evaluations. If the resident forms an evaluation and then is not present for your reevaluation, the coding must be under your own code and not under a teaching physician code. In the critical care unit, a physician and a resident may provide critical care treatment. You, however, must document that you treated the patient jointly with the resident, directly supervised the resident with the full amount of time needed for the code, directly managed the patient’s care you must reference the resident’s note in the documentation and reflect discussions with the resident concerning the patient’s stabilization and the consultation.

If a procedure is performed, the physician must directly supervise the entire procedure in order to bill for the procedure. There is a primary care exception. In some cases, Medicare allows a teaching physician to get paid when a resident provides an E/M service without the teaching physician’s direct supervision. This exception applies only to primary care practices, but these practices must be located in the outpatient department of a hospital or another ambulatory care center and not at a private physician’s office. Other rules require that the physician may supervise no more than four residents at a time and must be immediately available to help the resident. This means that the physician must be on the premises and not at home, supervising. The physician needs to ensure that the resident provides reasonable and necessary services and must