Wiki Teaching physicians/residents

[Lanie Christman]

If a resident sees a patient in the ER-performs a visit and then a reduction of a fracture, then calls the teaching physician (at home) to review post reduction films....I know that the teaching physician may not bill for the visit or the procedure. However-when the patient presents to the office for follow up to see the teaching physician....would the teaching doc bill for a new or an established visit?
I personally think this would be established since the resident is a member of the Ortho dept--but playing devils advocate to myself...the resident is not recognized by the insurance company and no charges have been officially billed..thus indicating a new patient visit.

Any information, thoughts would be greatly appreciated!
Thanks!!
Lanie

 

[FTessaBartels]

New Patient

We had this exact same scenario and our Compliance office stated that we should code the first billable service with the new patient code. (The resident may be a part of your Ortho team, but the resident is not being paid by your practice.)

If it is a commercial payor ... you may be able to bill for the fracture care provided by the resident under the supervision of a teaching physician. Our commercial carriers do not require physical presence of the TP - supervision can be by any means of modern communication including fax and phone for the commercial payors.

F Tessa Bartels, CPC, CEMC

 

[Lanie Christman]

That is wonderful information--I am just learning all of the rules for teaching physicians...Thank you for your time!! Lanie