Wiki Medical Student documented as performing procedure

[maryir]

Can a medical student perform or assist in a surgical or procedural service?

The attending attested that they were there during the entire procedure and there is a resident that states the same. There are multiple procedures which occurred over a week. One procedure was specifically documented by the medical student where they stated: I then performed XXX. Other surgical documentation lists the medical student as an assist (resident entered documentation and attending attested).

It has been my understanding a medical student could only be a scribe for a service. Since they are not a licensed practitioner they should not be actually performing or participating in a surgery or procedure.

Where can I locate specific guidelines addressing this issue? If location makes a difference - all services performed in CA (bay area).

 

[thomas7331]

You're correct that they are not licensed providers so you certainly can't code or bill for any services that they personally perform. Whether or not they are allowed to perform it is a very different question though.

If I were in your place, I wouldn't try to search for guidelines on this, but would just refer the concern to either your compliance officer or the director of the teaching program. Students do have to learn the procedures that they'll eventually be performing, and they do routinely participate in procedures with their instructors. What the limits of their role should be in this context is a medical/legal question that involves the details of the regulation of a physician teaching program and is really outside the scope of coding work. And it may just be a misunderstanding of how they should be documenting. Most likely the student isn't really 'assisting at surgery' in the same sense that a provider would be but is rather just performing some of the rudimentary elements of the surgery under close supervision during the course of the procedure.

I think you have a valid concern, but it's one that should be addressed by someone with a different background that what you'll find here on the coding forum.

 

[pnwcoder]

Can a medical student perform or assist in a surgical or procedural service?

The attending attested that they were there during the entire procedure and there is a resident that states the same. There are multiple procedures which occurred over a week. One procedure was specifically documented by the medical student where they stated: I then performed XXX. Other surgical documentation lists the medical student as an assist (resident entered documentation and attending attested).

It has been my understanding a medical student could only be a scribe for a service. Since they are not a licensed practitioner they should not be actually performing or participating in a surgery or procedure.

Where can I locate specific guidelines addressing this issue? If location makes a difference - all services performed in CA (bay area).

I'm located in Oregon and work for a large hospital system (a system that has other locations in other states) and now seeing a lot of student encounters doing procedures in clinics (IUD removals/insertions, laceration repairs, biopsies etc) and also can't find anything in guidelines if these can be coded. I have asked my manager however they basically have advised to treat like a resident (if the mentoring provider is present and documents as required) but of course we have to code/bill with service provider being the mentor unlike when resident does it which is coded/billed as service provider being resident with GC and mentoring provider as billing provider. This whole thing makes me very uncomfortable, especially with Medicare patients, but I have requested my manager give me directions in writing to hopefully cover myself if we ever have an outside audit.