Medicare Teaching Rules

sarahpoe

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I am currently coding/auditing for a teaching institution. I am trying to obtain coding guidance in regards to inpatient consultations performed by a resident, and the attending does not see the patient until the following day. Since Medicare does not allow consultation CPTs, these are typically converted to the applicable initial inpatient hospital visit. CMS has the teaching physician rule that if a patient is admitted late night by the resident, and the physician sees the patient the next calendar day, the initial hospital visit can still be billed on the day the teaching physician sees the patient. Example:

Resident admits patient on 03/12/2017, and teaching physician see the patient on 03/13/2017- Initial hospital visit 99221-99223 is billed on 03/13/2017 when the appropriate teaching physician attestation statement links the teaching physicians documentation to the resident's documentation on 03/12/2017.

My question is if this rule can be applied to consultations since they are submitted with initial hospital visits CPTs 99221-99223, or does the teaching physician report a subsequent hospital visit on the day they see the pateint? Same scenario:

Resident completes a consultation on 03/12/2017, and the teaching physician sees the patient on 03/13/2017. Report 99221-99223 or 99231-99233?

Any guidance would be much appreciated?

Thank you
 

Quaker

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I am currently coding/auditing for a teaching institution. I am trying to obtain coding guidance in regards to inpatient consultations performed by a resident, and the attending does not see the patient until the following day. Since Medicare does not allow consultation CPTs, these are typically converted to the applicable initial inpatient hospital visit. CMS has the teaching physician rule that if a patient is admitted late night by the resident, and the physician sees the patient the next calendar day, the initial hospital visit can still be billed on the day the teaching physician sees the patient. Example:

Resident admits patient on 03/12/2017, and teaching physician see the patient on 03/13/2017- Initial hospital visit 99221-99223 is billed on 03/13/2017 when the appropriate teaching physician attestation statement links the teaching physicians documentation to the resident's documentation on 03/12/2017.

My question is if this rule can be applied to consultations since they are submitted with initial hospital visits CPTs 99221-99223, or does the teaching physician report a subsequent hospital visit on the day they see the pateint? Same scenario:

Resident completes a consultation on 03/12/2017, and the teaching physician sees the patient on 03/13/2017. Report 99221-99223 or 99231-99233?

Any guidance would be much appreciated?

Thank you
Hello. I'm auditing the exact scenario now and Medicare deleted the TP scenarios from their manual. So what do we do now? If interested, would you be willing to discuss this?
 
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