Wiki Teaching physican question


Lumber Bridge, NC
Best answers
We are a teaching Family Practice facility. Situation: Resident sees pt and documents the hisory, exam, MDM. The resident asks the preceptor to see the pt. Preceptor comes in and sees the pt. The preceptor adds a "preceptor note" stating they examined the pt, discussed the assessment, dx, plan with the resident and they agree with the residents plan. I know normally when the resident sees a pt, they can not charge anything higher than a level 3 office visit. But what happens when the preceptor (MD) sees the pt? Is the preceptor note listed above enough to charge a level 4 under the MD or do they have to create their own office note? Thanks
Code for teaching physician

When the teaching physician has documented / attested to personal presence and participation in the service, you code/bill the appropriat level E/M and/or procedure all under the Teaching physician name/number according to the documentation.

Hope that helps.

F Tessa Bartels, CPC, CEMC
The pt has Medicare. Our teaching physicians attach a preceptor note to the residents document. Would this example of the Preceptor Note be sufficient:

Attending Note:

Precept Status: I examined the patient.

I have reviewed the patient's history and clinical findings documented by the resident. We have discussed the patient's history, assessment, management and follow-up plans. I agree with the note as written by the resident and concur with the assessment and plan. The care of this resident's patient is amended as follows: see note
Recommended Level of Visit: IV

Resident attended and attending note written by: Dr. Name and Date

Thank you for your help!!!
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Medicare says:
For purposes of payment, E/M services billed by teaching physicians require that they personally document at least the following:
• That they performed the service or were physically present during the key or critical portions of the service when performed by the resident; and
• The participation of the teaching physician in the management of the patient.​

The note does not show they were present for the key portions of the service or performed the service. Our TPs usually state they were present for the key portions of the exam and independently examined the patient.
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