ED Coding and Reimbursement Alert

Question: We currently have a few students working in our ED. In these cases, the chart note is linked to the supervising physician but signed by the student, then cosigned by the supervising provider. There is no note that the student saw the patient besides signing the note. Is this enough documentation for this situation?

South Carolina Subscriber

Answer: Yes, it should be based on recent changes. Last year, CMS issued a revision to a Medicare manual that allows teaching physicians to use all student documentation for billable services, provided that the teaching physician verifies the documentation. The teaching physician must either personally perform or re-perform the physical exam and medical decision making, but does not need to re-document.

In the past, only the medical student’s documentation of review of systems and past, family, and social history did not need to be re-documented by the teaching physician. CMS has not changed the requirement that any contribution of the student must be performed in the physical presence of the teaching physician or a resident. If the service is performed in the presence of a resident, then all teaching physician billing rules apply.

So, there must be physical presence and there is no rule saying the student must sign (but of course, it would be good practice). When selecting the code to report, it is what the teaching physician did that counts.