Cardiology Coding Alert

4 techniques can clarify confusing Medicare guidelines When a cardiologist works as a "teaching physician" (TP) and supervises a resident's services in an office or a hospital setting, you will have to report the physician's work using the teaching physician rules, according to the Medicare Carriers Manual (MCM), section 15016. Following the MCM guidelines for reporting TP services can trip up even the most seasoned coder. Read on for some expert advice for reporting E/M services and minor surgical procedures using the teaching physician rules. Intern Must Be a GME Student The MCM defines a resident as an intern or fellow who's enrolled in an accredited graduate medical education (GME) program, says Marti Geron, CPC, CMA, CM, coding and reimbursement manager at the University of Texas Southwestern Medical Center at Dallas. Note: For more information on requirements for a resident to achieve fellow/intern status, see "You Be The Expert: TP Rules and Med Students". 1. Report Office Consults Based on 'Key Portions' Let's say the TP provides an E/M service such as an office/other outpatient service (99201-99205, 99211-99215, or an office consultation 99241-99245) without the resident present. It may be possible to report under TP guidelines, experts say. How? If the resident and the TP perform the E/M service, the TP would have to duplicate the "critical and key portions" of the resident's services to bill under this guideline. Example: A resident sees a new patient complaining of chest pain when he breathes. The resident conducts an expanded problem-focused history and exam. The TP also evaluates the patient, performs an exam, and consults with the patient on his condition.

When filing this report, you should:

report 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and straightforward medical decision-making) to represent the office visit.
attach ICD-9 code 786.52 (Painful respiration) to 99202 to represent the patient's condition.
also attach modifier -GC (This service has been performed in part by a resident under the direction of a teaching physician) to 99202 to ensure that your Medicare carrier knows that you are reporting a service under the TP rules. The TP doesn't have to duplicate the resident's progress notes, Geron says. But the TP should refer to the resident's notes and state that the TP reviewed the resident's documentation and agrees with the diagnosis. Ensure Resident's Presence for Evaluations If the resident did not attend the TP's patient evaluation and also didn't perform a complete E/M service, the TP must bill and document the office visit as he would in a non-teaching setting, says Carol Pohlig, BSN, RN, CPC, senior coding [...]