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ED Coding and Reimbursement Alert

READER QUESTIONS:

Let Physician Hold the 'Key'

Published on Wed May 04, 2005

Question: We have a patient who presented to the ED with pelvic pain, and we're at a teaching hospital. According to the Medicare teaching physician guidelines, the attending physician must be present for the key portions of the E/M services. Should we consider the pelvic exam a "key portion" for this patient? If the resident performs the pelvic exam, does the attending need to be present, or can she do a GI exam as the key portion of the exam?


Pennsylvania Subscriber  
Answer: If the patient's chief complaint in the emergency department is pelvic pain, many clinicians would consider the pelvic exam to be the key portion. However, if the complaint is more diffuse lower abdominal pain, you might consider the abdominal exam to be the critical portion. Either way, CMS Transmittal 1780 allows the treating attending physician to determine which aspect of the encounter is key/critical.
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