ED Coding and Reimbursement Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer. Question: I've heard about the new teaching physician guidelines and was wondering to whom they apply. Do the less stringent documentation rules cover medical students? New York Subscriber

Answer: The simple answer to your question is "no." Many people have confused the applicability of the most substantive part of the new teaching physician guidelines that the teaching physician need only state what used to be documented: that he or she evaluated the patient and agrees or disagrees with the resident's findings. These revised rules apply only to the supervision of residents and fellows in teaching facility settings.

The rules raised considerable concern over how they cover a medical student performing a procedure with the TPphysically present. The rules state that a teaching physician can use the medical student's documentation of the medical history, family history, social and review of systems to support billing.

However, if the physician wants reimbursement for the medical student's work, the physician still has to reference these history elements and confirm the findings with the patient, adding his or her own HPI and physical exam. Those elements "must be redocumented," says Jeff Linzer, MD, MICP, assistant professor of pediatrics and emergency medicine at Emory University.

The medical student's requirement, though not loosened by other new TPrules, does contradict another new statement that "Medicare does not pay for any service furnished by a student."

However, CMS has clarified that it did not intend to change the medical student rules, and a teaching physician may still bill for procedures involving a student to the extent that a medical student is involved in the procedures under the personal supervision of the TP who is performing the service.

When a student is supervised by a resident while performing or providing a service, you can bill the service only if the TPwas there throughout the critical or key portion of the procedure providing direction for a major procedure (defined as greater than five minutes) and for the entire procedure for a minor procedure (defined as less than five minutes).