Message from Your Region 4 Representatives: Norma Panther and Kiosha Forston
Review the teaching physician changes to coding evaluation and management (E/M) services.
On April 26, the Centers for Medicare & Medicaid Services (CMS) released Change Request (CR) 11171 regarding evaluation and management (E/M) services performed by teaching physicians. The CR was issued to clarify manual language related to documentation of E/M services provided by teaching physicians. No examples of how these changes should be carried out are provided, review current processes carefully prior to making changes.
The following information (in italics) was added to Medicare Claims Processing Manual, chapter 12, section 100.1.1:
General Documentation Requirements
For purposes of payment, E/M services billed by teaching physicians require that the medical records must demonstrate:
- That the teaching physician performed the service or was physically present during the key or critical portions of the service when performed by the resident; and
- The participation of the teaching physician in the management of the patient.
The presence of the teaching physician during E/M services may be demonstrated by the notes in the medical records made by physicians, residents, or nurses.
- Exception for E/M Services Furnished in Certain Primary Care Centers
The patient medical record must document the extent of the teaching physician’s participation in the review and direction of the services furnished to each beneficiary. The extent of the teaching physician’s participation may be demonstrated by the notes in the medical records made by physicians, residents, or nurses.