ED Coding and Reimbursement Alert

Question: A physician in our ED recently started supervising a resident’s services. How can I best report evaluation and management services provided by a teaching physician?

Tennessee Subscriber

Answer: Your ED physician can get paid for E/M services and minor surgeries he performs in a teaching setting, as long as you send in the proper documentation along with the claim. When reporting your physician’s work in a teaching setting, file documentation according to the rules laid out in Section 15016 of the Medicare Carriers Manual. If the resident performs an E/M service, the teaching physician has to do one of two things:

1. Personally participated in key or critical aspects of the patient’s evaluation. So let’s say the resident performs a level 4 E/M service on a patient. In order to report 99284 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a detailed history; a detailed examination; medical decision making of moderate complexity…) for the encounter under teaching physician rules, the physician should write a note with case specific detail showing that he personally performed the key /critical portion of the patient’s evaluation

2. Be present during key portions of the exam. If he is present during the resident’s E/M evaluation, the teaching physician does not need to repeat the whole process, — but the teaching physician does need to document his physical presence during the key/critical aspects of the evaluation to support the claim. 

So if the resident performs a level 4 E/M service with the teaching physician present, you should report 99284. On the claim, include documentation that shows the teaching physician was present for the history, examination and MDM portions of the encounter.