# Help! Resident does delivery/OB ER triage



## mizzmaryb (Oct 21, 2013)

Hi all, 

I need some input on this matter.We have an OB provider stating if a resident sees our OB patient in the hospital and they so happen to be there at the time of the visit, we can bill for that admit/ob triage/obs, etc. 

Majority of our patients see our providers in clinic for normal prenatal care and the occasional complication visit. However, there are those visits that happen outside our clinic in the hospitals where our OB providers deliver. Would anyone happen to know if a hospital resident, not employed by us, sees one of our OB patients, charts the visit and states “discussed care w. attending Dr. A.”, if that could be billable on our side? Dr. A. is our provider. 
Another example, patient came into ER OB triage and was seen for suspected PROM. Resident charted everything and then decided to admit pt for OBS. End of chart note states "discussed care w. attending Dr. A and that's it. No additional documentation is done from our provider and ticket of admit would have been circled on the fee ticket. 

We are a teaching facility and so is the hospital but the residents are NOT employed by us and work for the hospital. This particular billing isn't my realm/expertise. I have already received the teaching physician guidelines from CMS and also ACOG's missed delivery guidelines.

Any info/feedback would be GREATLY appreciated! Thank you!


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## Prabhu.A CPC (Oct 22, 2013)

*CPT Pls,*

Aortic thrmbectomy, any one please advise CPT and ASA.


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## Bready (Oct 22, 2013)

*resident teaching facility*

the physician must see the patient, review the resident's notes, and document "I have seen and examined patient and agree/disagree with the above resident's note or I agree but have added/changed this rx etc" and sign the chart note.  then the physician can bill the patient using the resident's notes & exam (in addition to his/her own)for the appropriate E&M.  
I agree that if the physician does not see the patient, even if the resident is in telephone contact, the patient cannot be billed by the physician for an E&M service.  
However, we know physicians will disagree so good luck explaining to your doctor. Have your supporting documentation ready.


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## mizzmaryb (Oct 22, 2013)

Thanks Bready. So.... our physican who is the attending can bill for the service of the resident? (if all documentation is there, physician is physically there, etc)

even though the resident is not employed by us and is through the hospital's residency program??


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## Bready (Oct 28, 2013)

look at the CMS guideline on teaching physician. It states any physician who allows residents to be involved in the care of his/her patients. doesn't state they have to be employed by that particular physician just that he allows the resident to care for his patient so your doctor would qualify but your doctor must be present and available.  if your doctor was physically there, that is, with the resident, he could bill but if he was at some other location in the hospital and did not see the patient even though he may have been consulted by the resident, I would not bill for it.
its a gray area open to interpretation by doctors of what being present/available means.
sorry i missed your post. you've probably already billed out and that's okay


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