Teaching Physician Rules

Tags: rules teaching medicare inpatient

Definition

Rules governing billing when residents participate in patient care under physician supervision.

Key Requirements

Teaching Physician Must

1. Be physically present during key portions
2. Document presence and participation
3. Re-document resident’s note (or reference)

Physical Presence

Teaching physician must be physically present during critical/key portions of the service.

Documentation Options

Option 1: Re-documentation

Teaching Physician Note: “I saw and evaluated the patient. I agree with the resident’s findings and plan.” [Signature/Date/Time]

Option 2: Reference Resident note

Teaching Physician Note: “Resident’s note reviewed. I saw patient with resident. Findings confirmed. Plan approved.” [Signature/Date/Time]

E/M Service Levels

Service	Teaching Physician Requirement
Initial Care	Must perform key portions
Subsequent Care	Must perform key portions
Critical Care	Must be present for entire time
Procedures	Must be present for key portions

Time-Based Coding

Time Counting

Only teaching physician’s time counts toward total time. Resident time alone cannot be billed.

Attestation Examples

Acceptable

“I was present during the history and exam. I discussed the case with the resident and agree with the assessment and plan.”

Unacceptable

“Resident’s note reviewed and approved.” (Missing presence statement)

Critical Care Teaching

Requirement	Detail
Presence	100% of critical care time
Documentation	Must document total time
Billing	Teaching physician bills

Electronic Attestations

Many EHRs have built-in teaching physician attestation templates. Use them for consistency.

00 Inpatient ProFee Coding MOC Split Shared Visits Documentation Requirements Inpatient