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Question about billing E/M visits for a teaching physician working with a resident

  1. #1
    Default Question about billing E/M visits for a teaching physician working with a resident
    Medical Coding Books
    Does anyone have a physician who is working as a teaching physician with a resident at a hospital? Our physician is working with a resident and they are seeing patients in the hospital, as outpatients, so we are dealing with 99201 - 99205 and 99211 - 99215.

    When a teaching physician is working with a resident physician at the hospital, and the visits are billed under the teaching physician's name, what part of the visit must the teaching physician perform, if any? Or does the resident see the patient, and discuss the visit/plan of care with the teaching physician and all the charges are billed under the teaching physician's name as residents cannot bill?

    Sorry, I'm a little confused with how the billing is done in this situation. Because I am wondering if it's an established patient, then would "incident to" guidelines apply?

    But what happens when it's the resident performing the visit and the patient is new, so "incident to" would not apply - how are these visits then billed?

  2. #2
    New Windsor, New York
    Default Teaching physician guidelines
    Instead of using incident-to, this sounds like you need to follow the teaching physician guidelines. Instead of trying to explain them all here, I am going to give you the link to where you can find them on CMS:


    Director, Health Information Management
    HealthAlliance of the Hudson Valley
    Kingston, NY

  3. #3
    Thank you - that helped a lot!

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