Neurosurgery Coding Alert

Here's what modifier to use for the primary-care exception. You can ensure that your neurosurgeon 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 neurosurgeon works as a "teaching physician" (TP) and supervises a resident's services in a clinic or hospital setting, you will have to report your physician's work using the teaching physician rules, according to the Medicare Claims Processing Manual (MCPM), Chapter 12, Section 100. The MCPM defines a resident as an intern or fellow who's enrolled in an accredited graduate medical education (GME) program. Experts offer four field-tested strategies for reporting E/M services and minor surgical procedures using the teaching physician rules. Report Outpatient Services Based on -Key Portions- Let's say the TP provides an E/M service such as an office visit (99201-99205; 99211-99215) or an outpatient consultation (99241-99245) without the resident present. The TP may be able to use some of the resident's work under TP guidelines, says Melanie Witt, RN, CPC-OGS, MA, an independent coding consultant in Guadalupita, N.M. How? "If the resident also performed the E/M service the TP performed, your neurosurgeon would have to duplicate the -critical and key portions- of the resident's services to bill under this guideline," Witt 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 who wants a second opinion regarding a proposed spinal condition treatment. The resident conducts an expanded problem-focused history and exam. All of this is documented in the resident's progress note. The TP also 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). 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," Witt says. The TP's note can refer to the resident's notes and state that the TP reviewed the resident's medical documentation and agrees with the diagnosis. Ensure Resident's Presence For Evaluations If the resident did not perform an independent patient evaluation, or did not perform the patient evaluation in conjunction with the TP, the TP must perform, document, and bill the office visit as he or [...]