# Teaching Physicians....HELP!



## MandyFlagg (Sep 25, 2012)

Ihave exhausted my searches and I can't find anything.  Wondering if  you can help me and lead me in the right direction.

Teaching Physician guidelines:
I have the medicare and I also found a nice article from AHIMA but it does not cover this senario.

The policy I have made for our academic practices is that the attending (preceptor) must document that they personally saw and examined the patient and then give me a piece of history, exam and medical decision making, even for sub hospital days and established patients.  We are conservative here.  What are your thoughts?

For Family Practice Resident:
Also, for the hospital setting I keep running into this senario.  A patient gets admitted, the preceptor (this is a group and is assigned to the night attending) accepts the admission late in the day or overnight.  The resident see's the patient when the admission is accepted (late in the day or overnight)  the preceptor is not physically in the hospital.  The resident then calls and precepts (does the same steps with the physician over the phone that they would do if they were standing next to them)  then writes all the orders and dictates.  Problem is they use the actual date of admission as their date of service.  The preceptor (could be the same as the night preceptor but ususally is whoever is assigned to rounding that week) then rounds on the patient the next day (usually morning) and actually does the face to face portion of that admission (usually the day after the resident has dictated).  I know I bill the date that the preceptor does their documentation but is it still OK to combine the residents note with the preceptor?  Also, the dictation should list the physician that actually does the H&P with the resident correct?

Ok same senario but with a Family Practice resident rounding as an elective with pediatric hospitalist?

I think this is giving me grey hair!


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## FTessaBartels (Sep 28, 2012)

*Teaching Physician*

The Teaching Physician (TP) must attest to his/her presence and direct treatment of the patient.  If the resident sees the patient late at night on 24Sep12, and the TP does not see the patient until the morning of 25Sep12, then the DOS for the Initial Hospital Visit is 25Sept12.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## tammymlance (Oct 12, 2012)

Can you tell me where to reference this?  I am having the same issue.  
My resident will see the patient, but we cannot bill for the H&P b/c the teaching did not see patient until the following day..... HOWEVER, someone has told my director that there is a 24 hour rule that the attending can sign up to 24 hours after and we can still bill for H&P.  
Tammy


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## FTessaBartels (Oct 22, 2012)

*H&P vs Initial Hospital Visit*

Get the term "H&P" out of your head.  "H&P" is a hospital requirement.  Yes, it's usually the format used to document the initial hospital visit, but it's not required to use the 99221-99223 code.

On the date of service when the Teaching Physician documents his/her initial hospital visit with the patient, you will code the 99221-99223 code based on the level of service documented. The TP may use the residents previous DOS note for the ROS and PFSH, but must indicate that s/he (the TP) reviewed this information collected by the resident.  The TP must separately document the chief complaint, HPI, Exam and MDM. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## MandyFlagg (Oct 23, 2012)

This is the opposite of what I was instructed and read recently in an article.  It was stated if the physician (TP) tied their note from the next morning to the residents documentation from the previous evening they did not need to re-document?  I am having a hard time with this and do not want to educate until I have the concrete evidence and have confidence in what I am instructing to do


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## MandyFlagg (Oct 23, 2012)

Here is the article that I was recently sent.  

http://codapedia.com/articlePrint.cfm?id=462

This actually references the IOM chapter 12


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