Wiki Coding exams for medical students with time

Create Wiki Sort by date
C

Cheezum51

True Blue
Messages
564
Location
Virginia Beach, VA
Best answers
0
I know that since 2018 CMS has allowed medical students to document findings in an exam as they examine a patient, as long as they're supervised by a resident or attending physician, Therefore, what they document would be used to determine the E/M codes billed for the examine.

Here's my question: Some exams, such as for a TBI patient, usually take a long time, even when performed by a licensed physician, and could be billed based upon time when they exceed the level 5 codes times. If a student performs the majority of the exam, can the time they use to do that be used to code the time, since they usually work more slowly than an experienced doctor? If their time can be used, would you be comfortable billing for the entire time or would you reduce that by some factor?
 
0
0
You can't count medical student time spent alone. My understanding is that you can only count the time of the billable provider.
This is Medicare's guidelines about teaching physicians. Relevant excerpts below.
● When total time decides the office or outpatient E/M visit level, only include teaching physician-presence time. We pay the graduate medical training program separately, which includes the resident’s time providing services with a teaching physician, under Medicare Part A. During the PHE, you may include the teaching physician’s time when they’re present through audio/video real-time technology in the total visit level selection time.

Time-Based Codes
When you make the claim, we require the teaching physician’s presence during time-based procedure codes. For example, we may pay a code specifically describing a 20–30 minute service only if the teaching physician is physically present 20–30 minutes.
Don’t add time the resident spends when the teaching physician wasn’t available to time the resident and teaching physician spends with the patient, or time the teaching physician spends alone with the patient.
Time-based codes:
● Individual medical psychotherapy (CPT codes 90804–90829)
● Critical care services (CPT codes 99291–99292)
● Hospital discharge day management (CPT codes 99238–99239)
● Office and or outpatient E/M visit codes when you use the total time to select the visit level
● When selecting the visit level, only count time the teaching physician spent doing qualifying activities listed by CPT (with or without direct patient contact on the encounter date), including the teaching time present when the resident does those activities
● Prolonged services (CPT codes 99358–99359)
● Care plan oversight (HCPCS codes G0181–G0182
Students Providing Evaluation & Management Documentation
● Students taking part in and contributing to a billable service must do it in the physician’s or resident’s physical presence, and meet teaching physician billing conditions. E/M services include separately billable services, except systems review and or past family and social history.
● Students may document services in the patient medical records. Teaching physicians must verify all student medical record documentation or findings, including history, physical exam, and medical decision-making.
● Teaching physicians must personally do (or re-do) all billed physical exam and medical E/M decision-making services. They can verify any student documentation in the medical record rather than re-documenting it.
 
You must log in or register to reply here.
Top