Question: My internist works at a teaching hospital, and I've heard about a "primary-care exception." What is it and how does it apply to my work? Answer: The "primary-care exception" is a Medicare guideline that allows teaching physicians (TP) to bill for You should also attach modifier -GE (This service has been performed by a resident without the presence of a teaching physician under the primary-care exception) to all codes that you report under the exception. - Answers for You Be the Coder and Reader Questions were answered by Kathy Pride, CPC, CCS-P, a coding consultant for QuadraMed in Port St. Lucie, Fla.; and Bruce Rappoport, MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for Rachlin, Cohen & Holtz LLP, a Fort Lauderdale, Fla.-based accounting firm with healthcare expertise.
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E/M services that a resident provides, even though the TP didn't provide direct supervision. The exception applies only to primary-care practices, and you can report only E/M new patient codes 99201-99203 and established patient codes 99211-99213.
In addition, your office must be located in the outpatient department of a hospital or another ambulatory care entity, not a physician's office away from the center, and you cannot use the exception for services provided during a home visit, according to the Medicare Carriers Manual (MCM).
To meet Medicare's documentation requirements for reporting 99201-99203 and 99211-99213 under the exception, make sure you can satisfy the following MCM criteria, which state that your TP should:
Further, the TP must document the extent of his participation in the review and direction of the patient care.