HCA Session III. Teaching Physician Rules Time Based Coding; Counseling Q&A Prior Sessions. Teaching Physician Rules. The purpose of this session is to provide you with the basic criteria for physician documentation of services provided in a teaching setting.
Teaching Physician Rules
Time Based Coding; Counseling
Q&A Prior Sessions
The purpose of this session is to provide you with the basic criteria for physician
documentation of services provided in a teaching setting.
Medicare Benefits: Part A (Hospital); Part B (Physician)
In a teaching hospital, the hospital receives grant dollars (GME – Graduate Medical
Education) for resident services. Residents cannot additionally bill for their individual
services above and beyond this grant funding. However, the teaching physician can bill
for patient care provided in collaboration with a resident to individual patients and bill
Medicare Part B benefits under their Medicare provider ID Number.
You may bill for:
Services personally furnished by a physician who is not a resident.
A teaching physician who is physically present during the “critical; key portions” of the service that a resident performs his/her patient evaluation and/or procedure.
E/M services billed by teaching physicians requires that they “personally” document the
When the teaching physician refers to a note obtained and documented by the
resident (eg. HPI and physical examination) the teaching physician need not
repeat the documentation of these components in detail. But, rather the
documentation of the teaching physician may be brief, summary comments
that relate to the resident’s entry and which confirm or revise the key elements
defined such as a summary of:
For example, the teaching physician does not need to restate the :
However, the teaching physician must document that he/she personally performed or
was physically present during the critical or key portion(s) of the examination and was
directly involved in the overall assessment/plan (eg. management) of the patient’s care.
“I performed the history & physical examination of the patient and discussed his
management with the resident. I reviewed the resident’s note and agree with the
documented findings and plan of care for this patient”.
“I saw and evaluated the patient. I agree with the findings and the plan of care as
documented in the resident’s note.” Or
“I saw and examined the patient. I agree with the resident’s note except the heart
murmur is louder, so I will obtain an echo to evaluate further”.
“I was present with the resident during the history and exam. I discussed the case with the resident and agree with the findings and plan as documented in the resident’s note”.
“I saw and evaluated the patient. Agree with resident’s note but lower extremities are weaker, now 3/5; MRI of L/S Spine today.
The following are examples of unacceptable documentation:
“Agree with above”. Followed by legible countersignature or identity.
“Rounded, reviewed, agree”. Followed by legible countersignature or identity.
“Discussed with resident. Agree”. Followed by legible countersignature or identity.
“Seen and agree”. Followed by legible countersignature or identity.
“Patient seen and evaluated”. Followed by legible countersignature or identity.
A legible countersignature or identity alone.
Documentation by a student is limited to the:
The teaching physician may “not” refer to the student’s physical examination or decision
making documented in his/her own note. He/she must re-document the HPI and
personally perform the exam.
For procedure code selection to be determined on the “basis of time”, the teaching physician must be
physical present” for the period of time for which the claim is being made.
Payment will not be made for time spent by the resident in the absence of the teaching physician.
Examples of non-billable resident services:
“Moonlighting” refers to services performed outside the scope of an approved GME program.
Medical, surgical, whether inpatient, outpatient or ER are billable under Part B (Physician)
when the criteria below is met and the services are considered to have been furnished by
The individuals in their capacity as a “physicians” vs. ‘resident”. Criteria:
Example: 15 min visit – 8 minutes was a discussion, remainder HPI, Exam.
code 99213 (=15 minutes total time).
(NEW: not seen within 3 yrs by anyone in same specialty)
99201 = 10 minutes
99202 = 20 minutes
99203 = 30 minutes
99204 = 45 minutes
99205 = 60 minutes
99211 = 5 minutes
99212 = 10 minutes
99213 = 15 minutes
99214 = 25 minutes
99215 = 40 minutes
Based on payor benefits available to primary care physicians whenever applicable