Eli's Rehab Report


Ask, 'Was the Physiatrist Immediately Available?'

Question: If the physiatrist has to leave the room for a few minutes during an E/M service performed in a teaching physician (TP) setting, does that mean we cannot bill under TP guidelines?

Arkansas Subscriber

Answer: The teaching physician rules aren't quite that stringent. As long as the TP is immediately available to return to the E/M visit, the TP does not have to be physically present for non-key portions of a service lasting more than five minutes.

For example, the resident is performing a level-four E/M service on an established patient under TP supervision. The TP gets an urgent call from her daughter and leaves the room for three minutes while the resident monitors the patient's vital signs, then returns for the rest of the visit.

You should:

• report 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history, a detailed examination, medical decision-making of moderate complexity)

• attach modifier GC (This service has been performed in part by a resident under the direction of a teaching physician) to 99214 to show that the physician performed the service under TP guidelines.