Pulmonology Coding Alert

Question: A physician in our practice 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 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 (MCM).

If the resident performs an E/M service, the TP has to do one of two things:

1. Duplicate key portions of the exam. For example, the resident performs a level-four E/M service on an established patient before the attending physician sees the patient. To 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) for the encounter under TP rules, the physician should assess the patient's condition (confirming the history and exam) and participate in the management.   

The documentation for this claim should reflect the intern's involvement in the service. The TP must review the intern's note and agree or disagree, and document the visit's key portions demonstrating physical presence and management.

2. Be present during key portions of the exam. If he is present during the intern's E/M evaluation, the TP does not need to repeat any portions of the exam -- but the TP does need to document his presence on the claim. So if the resident performs a level-four E/M service on an established patient with the TP present, you should report code 99214.

On the claim, include documentation that shows the TP was present for the history, examination and MDM portions of the encounter. This documentation of the TP's involvement must be provided by the TP himself, not the intern. On the claim, the TP must agree or disagree with the intern's note, and show evidence of his presence and participation in the patient's management.