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4th year Residents performing circumcisions

  1. Default 4th year Residents performing circumcisions
    Medical Coding Books
    Hi AAPC Members,

    Does all residents including 4yr require Direct Physical Presence of an attending with documentation to perform surgery's ex; circumcisions to submit charges? Our 4th yr residents are certified to perform a circumcision under Indirect supervision according to the hospital and have submitted charges to bill under attending physician because of course they can't submit under themselves. However when looking for documentation to support the services by the attending I was unsuccessful. Can anyone provide me with any guidance stating that it is okay for a resident to perform a procedure without documentation from the attending stating their participation. This situation does not qualify for moonlighting billing because resident is participating in the scope of their specialty. All resources will be appreciated

  2. #2
    Default
    Quote Originally Posted by jeannette79 View Post
    Hi AAPC Members,

    Does all residents including 4yr require Direct Physical Presence of an attending with documentation to perform surgery's ex; circumcisions to submit charges? Our 4th yr residents are certified to perform a circumcision under Indirect supervision according to the hospital and have submitted charges to bill under attending physician because of course they can't submit under themselves. However when looking for documentation to support the services by the attending I was unsuccessful. Can anyone provide me with any guidance stating that it is okay for a resident to perform a procedure without documentation from the attending stating their participation. This situation does not qualify for moonlighting billing because resident is participating in the scope of their specialty. All resources will be appreciated
    Jeanette, under CMS Teaching Physician guidelines, when minor procedures are performed by a resident, the Teaching Physician must be present during the entire procedure. The TP's documentation should reflect his or her entire presence.

    Here's the direct quote from the CMS: "3. Minor Procedures
    For procedures that take only a few minutes (five minutes or less) to complete, e.g., simple suture, and involve relatively little decision making once the need for the operation is determined, the teaching surgeon must be present for the entire procedure in order to bill for the procedure."

    This is the link to CMS internet manual, 100-4 : http://www.cms.gov/manuals/downloads/clm104c12.pdf

    Scroll down to Chapter 12, then look under Teaching Physician Services to see all the detail.

    Best,
    Jettman

  3. #3
    Location
    Milwaukee WI
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    4,466
    Default Commercial carriers
    Commercial carriers ... however .... usually only require supervision by any modern means of communication. SO the Teaching physician may be in the next operating suite, or even at home, as long as s/he is available by phone to supervise the resident.

    Check with your payer. If it's Medicare or Medicaid you won't be able to bill. If it's commercial, you may be able to.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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