# Time Based Consult in Teaching Facility



## deyoung (Mar 3, 2008)

I am new to E/M and trying to understand how to have our residents and teaching physicians (TP) correctly document an inpatient consult. 

This is my understanding of what's required...please provide feedback:

1. Total time of visit (entered by resident).

2. Reference that visit was >50% counseling and/or coordination of care (checked off by resident).

3. TP performed the service or was physically present during the key or critical portions (this has to be documented by TP & not resident).

4. Participation of TP in management of patient (documented by TP, not resident). 

5. Time TP was actually physically present (I know they can only bill for their time, but not sure if this is required in note...but then how would I know their time?).

6. Description of counseling/coord. of care topics. (Do both the residents note and TPs note have to have this?)

7. Request for consult (is this required in the consultants note in a shared record? or is it just okay that the referring Dr documented the request? Is it my responsibility as the consultant to make sure the ref Dr documented the request?)

8. Reason for consult

9. Report from consultant in shared record.

Whew! Sorry so long! Thanks so much for the feedback!


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## sundaey (Mar 6, 2008)

Hi there,
I work for the school of medicine, and whenever our docs see pt's in CC, they have to document the time, it has to be 30 minutes or more, and signed by both the resident and the attending. the consult has to have all of the elements that it requires, and the attending has to dictate their own note in order for them to get the consult.
hope that this helps.


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## grahamki (Mar 7, 2008)

Good Morning,

I will try to answer your questions by how you have them number.  I work in a teaching facility as well for Psychiatry so we sort of have a template that our residents use when performing a consult either inpatient or outpatient. 

So if your coding by time base consults the 1. time has to be documented by the teaching/attending physician and the documentation has to reflect that as well. 

2.And it must be referenced that 50% or more was to counseling and coordination of care.  

3. Teaching physician/Attending has to refer to the resident's note and either agrees to it and add addtional information to the note if he/she so wishes. The attending must also refer to the date the service was performed.  ( So if the attending comes in a hour after the resident and sees the patient then he must state something to the fact that he has reviewed the residents note of ( date ) and agrees with the documention and assessment).

4. Both Attending and Resident has to state whom asked for the consult and the reason why they are being consulted.  Remember they cannot state " refer" but have to say " Consult was requested by Dr. Who"  and the requesting physician has to document in the pts record that they are asking for the consult.

Hope this helps!

Kim


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## deyoung (Mar 12, 2008)

Mahalo nui loa!


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## deyoung (Mar 18, 2008)

Hi Kim,
I cannot find guidelines about the teaching physician and resident both having to document the request & reason for consult. Sorry, but they may ask me and I just want to be able to show the guideline to them if they ask. Could you please point me in the direction on where I can find that info? I checked CMS & the different books I have but don't see it. Thx!


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## member7 (Mar 19, 2008)

For some information on teaching physicians, check under the CMS website under internet only manuals and chapter 12 of the Medicare claims processing manual.

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf


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## deyoung (Mar 19, 2008)

Thank you, I had went through the manual prior and just went through it again but don't see any info that pertains to the teaching physician and resident both having to document the request & reason for the consult. 

Since a combination of the resident and teaching physicians note is used for documentation, I figured the residents mention of the request and reason would suffice...any feedback on this?

Thanks! I appreciate your help!


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