# Medical Student/Resident/Teaching Physician?



## renifejn (Feb 10, 2009)

I hope someone can help me out with this situation:

Medical student does entire H&P (99223), resident or fellow does linking statement to student adding a few things.  Teaching physician links to both resident and medical student.

Is this allowed?  Or because of the teaching physician guidelines the doc has to re-document the HPI and exam because the student can only document the ROS and the PFSH? 

Or because the resident or fellow linked to the medical student and the doc linked to both is this okay to bill?

thanks


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## SCanterbury (Feb 10, 2009)

Medicare only allows the teaching/billing physician to be credited for student work that involved obtaining and documenting information regarding the ROS and PFSH, and this can be done in the absence of the TP. Any other work performed by a student must be performed in the presence of the TP, and even then, no credit is given for it. It must be re-performed and re-documented by the TP. The fact that a resident observed the student while doing unapproved portions of the service (like the physical exam) is irrelevant for Medicare teaching physician policy. It wouldn't have mattered even if the TP would have been in the room. A student simply can not perform a physical exam and document this in the record and use this towards the teaching physician's E/M level.

The process that you described, where the student performed more of the service than is allowed by Medicare, had their note approved and signed by a resident, who then had their note approved and signed by the TP is not uncommon, but it is not compliant under Medicare's teaching physician guidelines.

Seth Canterbury, CPC, ACS-EM


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## FTessaBartels (Feb 10, 2009)

*NO*

I totally agree with Seth ... couldn't have said it better myself. 

F Tessa Bartels, CPC, CEMC


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## renifejn (Feb 10, 2009)

What if resident/fellow re documents hpi and exam...can the tp link to that?


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## FTessaBartels (Feb 11, 2009)

*Teaching Physician and resident*

The TP can (and usually does) link to the resident/fellow documentation of HPI, Exam, Assessment & Plan. Bear in mind, however, that the resident must be documenting *service that s/he provided *... not just repeating what the med student observed!  The teaching physician must then attest to his/her presence, participation in the history, exam and medical decision making, and sign/date the note. 

The ROS and PMFSH can be completed by anyone ... the patient him/herself, a medical student, the helpful person who just happens to be in the waiting room ... 

We have actually instituted a new form at our hospital so that Medical students have their own "H&P/consult" to complete which gives them the necessary training and practice without muddying the waters. A resident, fellow or faculty member must complete the official H&P; the teaching physician ALWAYS must attest to his/her presence, participation and sign/date the document. 

F Tessa Bartels, CPC, CEMC


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