ED Coding and Reimbursement Alert

Learn to bill correctly when doctors - and med students - work together If you want to get your emergency department physicians paid for evaluation and management (E/M) services and minor surgical procedures they perform in a teaching setting, you have to know these documentation and supervision requirements for the teaching physician rules, especially if you work in an academic setting.
 
When your physician works as a "teaching physician" (TP) and supervises a resident's services, you will have to report your physician's work using the teaching physician rules, according to the Medicare Carriers Manual (MCM), section 15016. Medicare recently released Transmittal 1780 to clarify some of the language in this section.
 
To appropriately report services under the teaching physician rules, make sure your resident meets Medicare's definition. The MCM defines residents as an intern or fellow who's enrolled in an accredited graduate medical education (GME) program, says Marti Geron, CPC, CMA, CM, coding and reimbursement manager at the University of Texas Southwestern Medical Center at Dallas. Experts offer four field-tested strategies for reporting E/M services and minor surgical procedures using the teaching physician rules. 1. Report E/M Services Based on 'Key Portions' You can report E/M codes if the TP personally furnishes the E/M service, such as an ED visit (99281-99285), without the resident present, said Jillian H. Kuruc, MHA, CPC, CCS-P, a clinical technical editor with Ingenix Health Intelligence in Binghamton, N.Y., during a session on the teaching physician rules at the Third Annual Coding, Billing, and Compliance Essentials Conference in Orlando, Fla.
 
If the resident also performed this E/M service, your ED doctor would have to duplicate or be physically present during the "critical and key portions" of the resident's services to bill under this guideline, Kuruc tells ED Coding Alert. The TP should define - and be able to defend - those critical and key portions, she adds.
 
If you had an acute exacerbation of asthma, the TP would need to be present for the key or critical components of the E/M service, but he doesn't need to be there for the nebulizer treatments.
 
The TP doesn't have to duplicate the resident's progress notes but should refer to the resident's notes and state that the TP reviewed the resident's medical documentation and agrees with the diagnosis, Geron says.
 
If the TP was not present for the resident's evaluation of the patient, and the resident did not document a complete E/M service, your physician must bill and document the visit as he would in a non-teaching setting, says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia. In other words, to support a 99284 claim, the doctor would have to document a [...]