Orthopedic Coding Alert

The following excerpt from Medicare Transmittal 1780 (Nov. 22, 2002) can help you determine whether your teaching physicians meet the new TP requirements:

 1. Evaluation and Management (E/M) Services: For purposes of payment, E/M services billed by teaching physicians require that they personally document at least the following:

 a. that they performed the service or were physically present during the key or critical parts of the service when performed by the resident; and

 b. the participation of the teaching physician in the management of the patient.

 When assigning codes to services billed by teaching physicians, reviews will combine the documentation of both the resident and the teaching physician.
 Documentation by the resident of the presence and participation of the teaching physician is not sufficient to establish the presence and participation of the teaching physician.
 On medical review, the combined entities in the medical record by the teaching physician and the resident constitute the documentation for the service and together must support the medical necessity of the service.

 To view the Medicare Carriers Manual's Teaching Physician Guidelines, visit the CMS Web site at
http://www.cms.hhs.gov/manuals/14_car/3b15000.asp#_15016_0.