Wiki GI physicians teaching hospitalist physicians to do colonoscopies

[stephmescher]

Hello,
Looking for some guidance- we have two hospital physicians that are training to do colonoscopies in our endoscopy unit. The GI specialist is in the room doing the supervision of the hospital MD- we are wondering if we are able to bill under the hospitalist because they are doing the majority of the procedure. We are not a teaching facility and the hospitalists are actual physicians- the teaching physician rules are specifically done with residents and interns so we are unsure if the applies to regular physicians.
We are requiring the hospitalist to do 140 cases supervised before going on their own.
Thanks
Steph

 

[thomas7331]

This kind of arrangement is generally known as 'proctoring'. You're correct that this is not a teaching arrangement and rules for teaching residents do not apply to this situation.

When this was done in the facility where I worked, we would bill the procedure under the physician who was actually performing it - the physician who is supervising and teaching is not eligible to bill. However, I would recommend that you get direction from your organization's management and/or compliance department on this to ensure that everyone is in agreement about how you're going to go about it and also to make sure that the physicians, including the proctor, are documenting appropriately.

 

[stephmescher]

This kind of arrangement is generally known as 'proctoring'. You're correct that this is not a teaching arrangement and rules for teaching residents do not apply to this situation.

When this was done in the facility where I worked, we would bill the procedure under the physician who was actually performing it - the physician who is supervising and teaching is not eligible to bill. However, I would recommend that you get direction from your organization's management and/or compliance department on this to ensure that everyone is in agreement about how you're going to go about it and also to make sure that the physicians, including the proctor, are documenting appropriately.

Thank you Thomas

 

[csperoni]

Agree with @thomas7331 that is is proctoring. When daVinci robotic surgery started becoming available, one of my physicians was a proctor, and received payment from the equipment company to teach and supervise other physicians. The supervising physician would not bill the insurance - only the physician performing the procedure. Your organization will have to decide how/if the supervising physicians are receiving any additional compensation, or if it simply part of their duties.

 

[TThivierge]

Hi Stephm
I d check with hospital management there if the payer has credentialed both doctors with NPI and payer assigned ID numbers for the claim for each provider. Some facilities use modifiers GR and GC linked with CPT code depending on payer (BC/BS and Medicare do use this). Plus a 2 attestation statement to show physician completed treatment thus guided by expert GI physician. Also add attending doc (the expert doc)on claim while hospitalist learning on the specific day & since signed attestation too. There may be some payer specific guidance on how many colonoscopies learning physician must do before reimbursement fully instead of a percentage.
This is just my two cents on the matter, but hope it helps you.
Lady T

 

[csperoni]

Hi Stephm
I d check with hospital management there if the payer has credentialed both doctors with NPI and payer assigned ID numbers for the claim for each provider. Some facilities use modifiers GR and GC linked with CPT code depending on payer (BC/BS and Medicare do use this). Plus a 2 attestation statement to show physician completed treatment thus guided by expert GI physician. Also add attending doc (the expert doc)on claim while hospitalist learning on the specific day & since signed attestation too. There may be some payer specific guidance on how many colonoscopies learning physician must do before reimbursement fully instead of a percentage.
This is just my two cents on the matter, but hope it helps you.
Lady T

Unless the hospitalist is an intern/resident/fellow in an approved training program, I would have to strongly disagree with -GC.
GC: This service has been done in part by a resident under the direction of a teaching physician.

The situation you described still seems like a proctoring situation. The facility wants the hospitalist physician to be trained/supervised by GI for a certain number of cases before they will give them full privileges to perform the procedure independently. The hospitalist is performing the procedure now, just with guidance/advice by a more experienced physician. As the GI is not actually performing the procedure, you cannot bill under the GI. In terms of the GI receiving payment, depending on what arrangements were made with the hospital, this may simply be considered part of their regular duties, or the hospital might pay them a certain rate for the day or case. Regardless, the payment (if any) should not be from the insurance as the GI did not do the procedure.