Wiki Questions regarding teaching physicians/residents

[pedscoder21]

Hi,

This question is regarding teaching hospitals with residents. I'll write a scenario:

A Resident is called to consult a patient on June 1. The teaching physician does not physically see the patient until June 2, and attests to the Resident's June 1 note saying, "Time of eval 9am June 2. I have reviewed and confirmed the history, ROS, exam, and review of contributing data as outlined by the resident. I have personally seen the patient. I agree with the findings and the plan of care as documented in the note." The teaching physician wants to bill 99253.

Questions:

1.Is this billable even though the teaching physician did not see the patient until the next day? Is there some sort of "time frame" rule?
2. Are there any circumstances where the teaching physician MUST be present with the resident in order to bill for certain services (like procedures)?
2. If the above scenario is billable, would the service be billed with DOS June 2?

Thanks in advance!!

 

[danskangel313]

Here's some info that may help:
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf

This one isn't applicable to everybody, but it has some useful information:
http://compliance.med.ufl.edu/compl...idents-note-in-support-of-a-billable-service/

With regards to billing without the teaching physician around, I've read in multiple places that the key is that the supervising physician has to meet with the patient soon afterwards, perform the key components AND document them, and can reference the resident's notes. The DOS would be the date the supervising physician personally saw the patient. If the supervising physician does not make statements as to personally doing X Y and Z, and instead just says "I met with the patient," I doubt that'll fly.

There's also a TON of information about time-based services.