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ED Coding and Reimbursement Alert

Reader Question:

Other Changes Covered by TP Rules

Published on Sat Feb 01, 2003

Question: Our practice has heard about the main change under the new teaching physician guidelines, regarding teacher physician documentation. Are there any other changes that we should know about?

California Subscriber

Answer: Yes, other incidental changes under the teacher physician guidelines will impact practices. Below are notable examples provided and commented on by Jeff Linzer, MD, MICP, assistant professor of pediatrics and emergency medicine at Emory University.

  • Clarification of "physical presence": The new TP guidelines define what Medicare means by "physically present" for the attending physician. The TP's physical presence is now defined as "being present in the same room as the patient or where the face-to-face service is provided," Linzer says.

    The new rules also clarify that as long as the physician is "immediately available to return to the procedure," he or she does not have to be physically present for non-key portions of a procedure lasting more than five minutes. Procedures that last five minutes or less, or procedures for which the opening and closing of the surgical field is the key component, still require the TP's physical presence for the entire procedure.

  • "Resident" status: Afellow has resident status regardless of whether the hospital counts the fellowship against its resident full-time equivalents, or whether the program is GME-approved or not. If the fellow has been given a faculty appointment, he or she has resident status as well.
  • Medical students: Medical students may not be considered as interns or residents. (See "You be the Coder" for more on medical students.)

    You Be the Coder and Reader Questions contributed by Jeff Linzer, MD, MICP, assistant professor of pediatrics and emergency medicine at Emory University; Marianne Wink, RHIT, compliance analyst and educator at Strong Health Compliance Office in Rochester, N.Y.; and reviewed by Mike Granovsky, MD, CPC, CFO, of Greater Washington Emergency in suburban Maryland.

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