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.

Do this: 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 TP has to do one of two things:

- Personally participate in key or critical aspects of the patient's evaluation. Suppose the resident performs a level-four E/M service on a patient. 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 TP 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.

- Be present during key portions of the exam. If he is present during the resident's E/M service, the TP does not need to repeat the whole process--but the TP does need to document his physical presence during the critical aspects of the evaluation to support the claim. So if the resident performs a level-four E/M service with the TP present, you should report 99284. On the claim, include documentation that shows the TP was present for the history, examination and MDM portions of the encounter.