Results 1 to 3 of 3

Guidelines for Residents and Teaching Physicians

  1. Unhappy Guidelines for Residents and Teaching Physicians
    Exam Training Packages
    I have been coding for about 6 years, but have never worked at a teaching hospital. As far as I can tell after looking at the CMS website, in order for a teaching physician to bill an E/M visit, he must see the patient and put an attestation on the documentation that he examined the patient and agrees with what the resident has documented. I am being told by my compliance officer and higher ups not to hold the charge until physician attestation has been added, just let the physician knows he needs to do it and go ahead and bill the charge. This goes against everything I have been taught. What should I do?

  2. #2
    Rome, Georgia Chapter - Rome Coding Professionals
    Default Teaching Physician Guidelines
    If the service involves a resident - without an attestation there is not a billable service. The guidelines state:
    "For purposes of payment, E/M services billed by teaching physicians require that they personally document at least the following:
    a. That they performed the service or were physically present during the key or
    critical portions of the service when performed by the resident; and
    b. The participation of the teaching physician in the management of the patient.
    When assigning codes to services billed by teaching physicians, reviewers will combine the
    documentation of both the resident and the teaching physician."

    At the time of coding - If you do not have appropriate documentation reflecting the extent of participation of the teaching phy. You may be coding a service that is not appropriate.


  3. #3
    Milwaukee WI
    Default I can't believe your compliance office said that!
    Our compliance office would NEVER tell us to bill out a service without the attestation statement on it. If, upon audit, they don't feel the attestation is sufficient to meet CMS guidelines they make us send a corrected claim and refund any payment.

    BUT ... Many commercial payers do not follow the same strict guidelines as Medicare / Medicaid. In fact, for most commercial payers, "supervision" is all that is required, and that can be via any means of modern communication (i.e. the resident called the attending faculty physician and receives verbal concurrence on the plan of treatment).

    I would send an email to compliance asking for clarification of the protocol when there is a missing attestation statement. Get a response in writing, and KEEP IT for your records.

    F Tessa Bartels, CPC, CEMC

Similar Threads

  1. Podiatry Teaching Providers/Residents
    By RebekahEvansCPC in forum Medicare Regulations
    Replies: 0
    Last Post: 02-18-2015, 09:56 AM
  2. Teaching Physicians supervising residents of another specialty
    By lverellen in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 01-10-2011, 08:17 AM
  3. Replies: 6
    Last Post: 10-13-2009, 12:27 PM
  4. Residents Listed as Referring Physicians on Hospital Claims?
    By dreampeddler in forum Medicare Regulations
    Replies: 0
    Last Post: 10-07-2009, 01:59 PM
  5. Teaching physicians/residents
    By Lanie Christman in forum Orthopaedics
    Replies: 2
    Last Post: 04-06-2009, 11:17 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.

Get OurFREE2017SalarySurvey.

We'll email you a link to our 2017 Healthcare Salary Survey when it is available so you can see your earning potential.