# Night resident note



## lverellen (Apr 17, 2011)

Please help with this scenario as presented to me by a collegue:

 Night float resident sees the patient late evening and does an H&P for the admission, The teaching faculty physician receives sign out and sees the patient with his/her team of residents in the morning and decides that the patient is able to be discharged.  Can the physician still bill a same day admit/discharge because they did review the findings and see the patient in the morning with the new team of residents and the physician did sign off on the resident's dictation of the H&P?  Or can they only bill for the discharge because they didn't see the patient with the night float resident.


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## FTessaBartels (Apr 19, 2011)

*Who is the payer?*

Who is the payer? This matters because Medicare (and other government payers) will not accept a counter signature from the teaching physician as adequate documentation of service provided, while most commercial payers allow this (supervision being by any means of modern communications, including available by phone). 

Let's assume this is a Medicare patient who is admitted by the resident in the evening on 4-1-11.

Teaching physician has his initial hospital visit with the patient on morning of 4-2-11 and determins patient can be discharged.  The TP's documentation (NOT the resident's) can be used to code 99234-99236 for services provided and documented on 4-2-11. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## lverellen (Apr 25, 2011)

*night resident note*

What you describe is what I came up with as well!  Thanks for the response.


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