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Teaching physicians/residents

  1. #1
    Default Teaching physicians/residents
    Medical Coding Books
    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!

  2. #2
    Milwaukee WI
    Default 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

  3. #3
    That is wonderful information--I am just learning all of the rules for teaching physicians...Thank you for your time!! Lanie

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