Wiki Question regarding residents

[Sandra Roberts]

This is a question that one of the residents posed and we have gotten varied answers from others, wanting to find out which is correct?
A residents admits a patient in the evening (before midnight). They do the admission and call the attending. The attending then sees the patient the next day and does their own H and P (documents their exam, assessment,etc).

Here is how we were billing:
Hosp day 1 (they were admitted at 21:00 by resident) – no billing
Hosp day 2 (when the attending does the attending H and P) as a hospital admit.
Hops day 3 subsequent visit (low mod complex)

We have been advised that if the attending does not come in a see the pt to bill the admission on Day 1, the attending cannot bill the admission the next day, but has to bill a subsequent visit. Now, we have been billing the admit H and P simply on the day when the attending sees the pt (hosp day 2).
How should we bill these? They happen a few times per week. (and having the attending come in to capture those charges is not going to happen – this was also a past suggestion – our faculty and me would revolt).
Thanks we are trying to make sure we do this correctly,
Sandy

 

[poxleitner]

I saw this on Todays Hospitalist, I thought I had seen that the physician has 24 hours, but don't have time at the moment to read all of the CMS guidlines regarding this statement...but it's a start for you, hope it helps.


Duties, billing and documentation
According to the CMS, supervising physicians are responsible for making sure that patients seen by residents receive the same caliber of care as if they were working by themselves. And to bill for a service as a teaching physician, you must personally perform key portions of the service or observe a resident performing those key components.

When supervising, your specific duties include the following:



reviewing the patient's history and physical examination, as performed by the resident;

personally examining the patient within a reasonable period of time after admission, which Medicare guidelines indicate is within 24 hours;confirming or revising the resident's diagnosis;

determining the patient's course of treatment;

frequently reviewing the patient's progress; and

making sure that interns and residents receive the supervision they need.


As far as billing supervised services, Medicare regulations are fairly straightforward: Physicians need to add a -GC modifier to the CPT code they're billing for. That modifier certifies that a teaching physician was present during the key portion of the service and was immediately available during the other parts of the service.

 

[Sandra Roberts]

Thanks!