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resident performing PE

denisek1028

Networker
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49
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Can a resident perform a PE and discuss this with the teaching physician in the clinic or does the teaching physician have to be physically present during the entire PE?
 

Chelle-Lynn

True Blue
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645
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Modesto, CA
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A resident is only allowed to work independently through the primary care exception rule (see rules) which applies to lower level E&M codes such as 99201-99203 or 99212-99213. It does not apply to physical examination. In these situations the teaching provider needs to be present for the examination or perform their own examination in addition to the resident.

There is no exception rule that allows the resident to work independently during these exams with only a review and signature from the teaching physician per Medicare/CMS guidelines.
 

mitchellde

True Blue
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13,308
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Columbia, MO
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have this article in my file which may help a better understanding but it is basically as Chelle-Lynn stated.


Question: I work in a residency setting and we use the primary care exception rule that lets residents bill up to level three without attending physician presence. Two questions: 1) How do we bill inpatient services with the GE modifier using the exception, and 2) Can we use the exception on preventive services like 99397?

Answer: As to the inpatient service portion of your question, the exception rule states that "the services must be furnished in a primary-care center located in the outpatient department of a hospital or another ambulatory care entity." So no, there is no case where you would use GE for an inpatient service, only GC. If residents are involved in inpatient care, the attending must meet the presence requirements and document it. If a resident sees the patient without attending presence, it is not a billable service.

The second question involves preventive services. According to the CMS guidelines:

"Medicare may grant a primary care exception within an approved GME program in which the teaching physician is paid for certain E&M services the resident performs when the teaching physician is not present. The primary care exception applies to the following lower- and mid-level E&M services: 99201, 99202, 99203, 99211, 99212, 99213.

"Effective January 1, 2005, the following code is included under the primary exception: Healthcare Common Procedure Coding System code G3044: Initial Preventive Physical Examination: face-to-face visit, services limited to new beneficiary during the first six months of Medicare enrollment."

The rules here pretty clearly define which codes can and can't be used. That last sentence says "code" — singular. I'm interpreting that to mean the other preventive service codes 99381-99397 are not eligible for the exception. That does not mean they can't be provided by a combination of resident and attending physicians and billed with a GC.
 

Jlarsen43

New
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2
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Medicare Primary Care Exception Rules

Can someone confirm for me whether you need to attest in writing to the MAC that the Primary Care Center is meeting all of the PCE conditions? Or do you just need to have something documented internally that we quality for the exception?

Thank you.
 

Chelle-Lynn

True Blue
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645
Location
Modesto, CA
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No attestation is required. You just need to make sure that your program meet the basic requirements and be able to provide that information if questioned. It is very informal.
 
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