Teaching Physician

RAjones

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CMS states the critical or key portions of the service must be performed by the teaching physician or they must be present and the teaching physician's management of the patient must be documented. I am having a discussion with 2 medical directors who state a canned message added in an addendum or a template used to check of what was reviewed by the teaching physician is sufficient. Is there anyone who has any experience coding and billing for an resident? I was thinking they need to add in their own exam elements and their agreement or addition to the residents management.

Thank you
Rebecca Jones CPC
 
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CMS states the critical or key portions of the service must be performed by the teaching physician or they must be present and the teaching physician's management of the patient must be documented. I am having a discussion with 2 medical directors who state a canned message added in an addendum or a template used to check of what was reviewed by the teaching physician is sufficient. Is there anyone who has any experience coding and billing for an resident? I was thinking they need to add in their own exam elements and their agreement or addition to the residents management.

Thank you
Rebecca Jones CPC

First thing to note is that the resident and the teaching physician must each have their own separate documentation.
(Sorry in advance for the length)

"Pursuant to 42 CFR 415.170, services furnished in teaching settings are paid under the physician fee schedule if the services are:
• Personally furnished by a physician who is not a resident;
• Furnished by a resident where a teaching physician was physically present during the critical or key portions of the service; or
• Certain E/M services furnished by a resident under the conditions contained in §100.01.C

Critical or Key Portion - That part (or parts) of a service that the teaching physician determines is (are) a critical or key portion(s).
Physically Present - The teaching physician is located in the same room (or partitioned or curtained area, if the room is subdivided to accommodate multiple patients) as the patient and/or performs a face-to-face service.

Documentation - Notes recorded in the patient's medical records by a resident, and/or teaching physician or others as outlined in the specific situations below regarding the service furnished. Documentation may be dictated and typed or hand-written, or computer-generated and typed or handwritten. Documentation must be dated and include a legible signature or identity. Pursuant to 42 CFR 415.172 (b), documentation must identify, at a minimum, the service furnished, the participation of the teaching physician in providing the service, and whether the teaching physician was physically present.

In the context of an electronic medical record, the term 'macro' means a command in a computer or dictation application that automatically generates predetermined text that is not edited by the user.

When using an electronic medical record, it is acceptable for the teaching physician to use a macro as the required personal documentation if the teaching physician adds it personally in a secured (password protected) system. In addition to the teaching physician’s macro, either the resident or the teaching physician must provide customized information that is sufficient to support a medical necessity determination. The note in the electronic medical record must sufficiently describe the specific services furnished to the specific patient on the specific date. It is insufficient documentation if both the resident and the teaching physician use macros only."

"Following are examples of unacceptable documentation:

“Agree with above.”, followed by legible countersignature or identity;

“Rounded, Reviewed, Agree.”, followed by legible countersignature or identity;

“Discussed with resident. Agree.”, followed by legible countersignature or identity;

“Seen and agree.”, followed by legible countersignature or identity;

“Patient seen and evaluated.”, followed by legible countersignature or identity; and

A legible countersignature or identity alone.

Such documentation is not acceptable, because the documentation does not make it possible to determine whether the teaching physician was present, evaluated the patient, and/or had any involvement with the plan of care."

page 152 https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf
https://www.cms.gov/Outreach-and-Ed.../Teaching-Physicians-Fact-Sheet-ICN006437.pdf
 

RAjones

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Thank you so much. I have spent hours researching and interpreting this information. I needed another source to affirm my findings.
Rebecca
 
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