ED Coding and Reimbursement Alert

Question: How much supervision, if any, does a teaching physician need to provide? How should it be billed?

Maine Subscriber

Answer: Supervision is absolutely required by teaching physicians for residents and interns. The documentation requirements differ depending on the insurance payer involved.

For Medicare patients, the residents and interns can be involved with, perform and document all portions of a patients chart. The supervising physician must be present during procedures that take the resident from three to five minutes to perform. For example, if a resident performs a three to five-minute lumbar puncture (62270*, spinal puncture, lumbar, diagnostic), the physician should be physically supervising the procedure, and the documentation should indicate his presence. The attending teaching physician must also document on the chart to indicate supervision.

The attending physician should document that he or she agrees with the residents note and should record additional or supportive information in each of the three key areas of the chart history, exam and medical decision-making. Therefore, every Medicare patients chart with resident documentation that is used for billing must also include documentation from the teaching physician that addresses all three key areas of the chart. Merely stating agree with above, supervised by me or participated in will not suffice. The combination of the residents and the teaching physicians notes can be used to support the documentation requirements for billing.

For procedures performed by residents, the teaching physician must be physically present for all minor procedures and document that presence. Minor procedures are defined by Medicare as those taking four to five minutes.

For major procedures (taking more than five minutes), the attending teaching physician must document the key elements of the procedure to indicate supervision for billing.

Remember, procedures are only billed under the teaching physician provider number. If adequate supervision/participation is not documented by the teaching physician, the ability to bill is lost.