Tags: coding/rules teaching medicare inpatient
Definition
Rules governing billing when residents participate in patient care under physician supervision. See -GC for even more details.
Key Requirements
Teaching Physician Must
- Be physically present during key portions
- Document presence and participation
- 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 99214
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.
-GC 00 Inpatient ProFee Coding MOC Split Shared Visits Documentation Requirements for Inpatient