Gastroenterology Coding Alert

Use these techniques to clarify confusing Medicare guidelines You can ensure that your gastroenterologist gets paid for E/M services and minor surgical procedures performed in a teaching setting -- if you know the documentation and supervision requirements for Medicare's teaching physician rules. When your gastroenterologist works as a "teaching physician" (TP) and supervises a resident's services in an office or hospital setting, you will have to report your physician's work using the teaching physician rules, according to the Medicare Carriers Manual (MCM), section 15016. The MCM defines residents 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. Experts offer 4 field-tested strategies for reporting E/M services and minor surgical procedures using the teaching physician rules. 1.Report Office Consults Based on 'Key Portions' Let's say the TPprovides 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, said Jillian H. Kuruc, MHA, CPC, CCS-P, a clinical technical editor with Ingenix Health Intelligence in Binghamton, N.Y., during a session on the teaching physician rules at Ingenix's Third Annual Coding, Billing and Compliance Essentials Conference in Orlando. How? If the resident also performed the E/M service the TPperformed, your gastroenterologist would have to duplicate the "critical and key portions" of the resident's services to bill under this guideline, Kuruc says. The TP should define -- and be able to defend -- those critical and key portions, she adds. Example: Let's say a resident sees a new patient complaining of heartburn. The resident conducts an expanded problem-focused history and exam, and prescribes some antacids. The TPalso evaluates the patient, performs an exam, and consults with the patient on his condition.

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), along with ICD-9 code 787.1 (Symptoms involving digestive system; heartburn). Tip: Don't forget to 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 teaching physician rules. The TP doesn't have to duplicate the resident's progress notes, but should refer to the resident's notes and state that the TPreviewed the resident's medical documentation and agrees with the diagnosis, Geron says. Ensure Resident's Presence For Evaluations If the resident did not attend the TP's [...]