Wiki Home Visits by Resident Physician

[sedel1156]

Hello everyone! I have a question regarding billing for resident physicians who perform a patient home visit. Does the Attending physician need to accompany the resident, or can they just 'review and discuss' the visit with the resident upon their return to the clinic? It seems like if the resident is not allowed to charge for the visit, they should not be doing home visits at all. Any help you all can provide would be greatly appreciated. Thanks so much!

 

[lgardner]

I agree with you the Resident should not be doing home visits on their own.

per CMS MLN bookelet Teaching Physicians, Interns, & Residents (emphasis added by me) :
For each encounter, use the CPT code definitions to select the E/M level service code and the documentation guidelines.
Teaching physicians billing E/M services must personally document:
●
You did the service or were physically present during critical or key resident-provided service and procedure portions
●
You take part in patient management
Your joint medical record entries (you and the resident) make up the documented service and it must cover medical necessity. Residents may not justify medical necessity by documenting the teaching physician’s presence during the service
______________________________________________
ALSO, in the same booklet, it mentions the CPT code sets, that were expanded for the covid PHE, that Residents are allowed to perform and this list DOES NOT include home visits.

 

[csperoni]

Agreed. Unless you're in an area where there is program with a primary care exception, my understanding is the teaching physician must be present in order to bill.
As for whether or not a resident should be providing these services without direct supervision, I would defer to the GME training program. Now, there could certainly be situations where everyone agrees this is the best option for patient care, it's just not billable.
Just like a specialty teaching physician may not go to the hospital on Sunday for rounds, and they are done by the resident who discusses with the MD. It's best care for the patient, but can't be billed.