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Pediatric Coding Alert

Reader Question:

Know the Meaning of 'Immediately Available'

Published on Fri Jun 11, 2004

Question: If the pediatrician has to leave the room for a few minutes during a procedure performed in a teaching physician (TP) setting, does that mean that we cannot bill under TP guidelines?

Arkansas Subscriber

Answer: The new teaching physician rules aren't quite that stringent. As long as the TP is immediately available to return to the procedure, the TP does not have to be physically present for non-key portions of a procedure lasting more than five minutes.

For example, the resident is performing a level-four evaluation and management (E/M) service on an established 5-year-old patient under TP supervision. The TP gets an urgent call from his son and leaves the room for three minutes while the resident is monitoring the patient's vital signs, then returns for the rest of the visit.

You should:

  • report 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history; a detailed examination; medical decision-making of moderate complexity)
  • attach modifier -GC (This service has been performed in part by a resident under the direction of a teaching physician) to 99214 to show that the physician performed the procedure under TP guidelines.

    Remember: Procedures that last less than five minutes or procedures that require opening or closing the surgical field as a key component still require the TP's physical presence for the entire procedure.

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