frazierm
New
I have a question regarding CMS Pub 100-04 Medicare claims processing transmittal 2303 (see below). I am trying to find guidance on what documentation the teaching surgeon has to have in order to show their responsibility / participation in the patient's preoperative and postoperative care? Do they have to document face to face time with the patient for both the preoperative and postoperative care or does there signature on the residents note suffice for this requirement. If it does not suffice for this requirement how should the charge be billed to show the reduction?
Examples:
1. A patient is seen in the ED for a consult by a resident and he or she makes the decision for surgery and the doctor only cosigns the note. Should the surgery be reduced if the teaching surgeon has no other preoperative notes but fully participated in the operative and postoperative care?
2. A teaching surgeon does a consult and makes the decision for surgery; however, only cosigns the resident's notes for all of the patient's postoperative care. Should the surgery be reduced as the teaching surgeon fully participated in the preoperative and operative care but only cosigned the postop notes?
A. Surgery (Including Endoscopic Operations)
The teaching surgeon is responsible for the preoperative, operative, and postoperative care of the beneficiary. The teaching physician?s presence is not required during the opening and closing of the surgical field unless these activities are considered to be critical or key portions of the procedure. The teaching surgeon determines which postoperative visits are considered key or critical and require his or her presence. If the postoperative period extends beyond the patient?s discharge and the teaching surgeon is not providing the patient?s follow-up care, then instructions on billing for less than the global package in ?40 apply. During non-critical or non-key portions of the surgery, if the teaching surgeon is not physically present, he/she must be immediately available to return to the procedure, i.e., he/she cannot be performing another procedure. If circumstances prevent a teaching physician from being immediately available, then he/she must arrange for another qualified surgeon to be immediately available to assist with the procedure, if needed.
Examples:
1. A patient is seen in the ED for a consult by a resident and he or she makes the decision for surgery and the doctor only cosigns the note. Should the surgery be reduced if the teaching surgeon has no other preoperative notes but fully participated in the operative and postoperative care?
2. A teaching surgeon does a consult and makes the decision for surgery; however, only cosigns the resident's notes for all of the patient's postoperative care. Should the surgery be reduced as the teaching surgeon fully participated in the preoperative and operative care but only cosigned the postop notes?
A. Surgery (Including Endoscopic Operations)
The teaching surgeon is responsible for the preoperative, operative, and postoperative care of the beneficiary. The teaching physician?s presence is not required during the opening and closing of the surgical field unless these activities are considered to be critical or key portions of the procedure. The teaching surgeon determines which postoperative visits are considered key or critical and require his or her presence. If the postoperative period extends beyond the patient?s discharge and the teaching surgeon is not providing the patient?s follow-up care, then instructions on billing for less than the global package in ?40 apply. During non-critical or non-key portions of the surgery, if the teaching surgeon is not physically present, he/she must be immediately available to return to the procedure, i.e., he/she cannot be performing another procedure. If circumstances prevent a teaching physician from being immediately available, then he/she must arrange for another qualified surgeon to be immediately available to assist with the procedure, if needed.