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.
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