College of Medicine Office of Compliance, Gainesville, Florida
COMPLIANCE TIP -

CMS Issues Changes for Teaching Physician guidance
(Services Involving Residents)

This message is intended for the Gainesville practice.

CMS adds clarifying language to their guidance on Teaching Physician documentation (services involving Residents), dated June 24, 2011, effective June 1, 2011.
(Last modification to this guidance was in 2002)

Link to PDF of entire Transmittal: https://www.cms.gov/transmittals/downloads/R2247CP.pdf

What is new:

Clarification on combination of services with hospital late at night resident visit with teaching physician the following day:

The clarification is consistent with College policy that has been in place for some time. Combining services with a resident from the previous calendar day only applies to hospital "late at night" services, and the teaching physician's note must document changes in the patient's condition and clinical course. College guidance remains that, as a matter of practice, such combined services fall within a twelve hour time window.

Scenario 4:

When a medical resident admits a patient to a hospital late at night and the teaching physician does not see the patient until later, including the next calendar day:

• The teaching physician must document that he/she personally saw the patient and participated in the management of the patient. The teaching physician may reference the resident's note in lieu of re-documenting the history of present illness, exam, medical decision-making, review of systems and/or past family/social history provided that the patient's condition has not changed, and the teaching physician agrees with the resident's note.
• The teaching physician's note must reflect changes in the patient's condition and clinical course that require that the resident's note be amended with further information to address the patient's condition and course at the time the patient is seen personally by the teaching physician.
• The teaching physician's bill must reflect the date of service he/she saw the patient and his/her personal work of obtaining a history, performing a physical, and participating in medical decision-making regardless of whether the combination of the teaching physician's and resident's documentation satisfies criteria for a higher level of service. For payment, the composite of the teaching physician's entry and the resident's entry together must support the medical necessity of the billed service and the level of the service billed by the teaching physician.

Expansion of eligible codes under primary care exception and ability to include one resident with less than 6 months experience:

Effective January 1, 2011, the following codes are included under the primary care exception: HCPCS codes G0438 (Annual wellness visit, including personal preventive plan service, first visit) and G0439 (Annual wellness visit, including personal preventive plan service, subsequent visit).

Teaching physicians submitting claims under this exception may not supervise more than four residents at any given time and must direct the care from such proximity as to constitute immediate availability. Teaching physicians may include one resident with less than 6 months in a GME approved residency program in the mix of four residents under the teaching physician's supervision. However, the teaching physician must be physically present for the critical or key portions of services furnished by the resident with less than 6 months in a GME approved residency program. That is, the primary care exception does not apply in the case of the resident with less than 6 months in a GME approved residency program.

Clarification of documentation required for Diagnostic Radiology Interpretation

6. Interpretation of Diagnostic Radiology and Other Diagnostic Tests

Medicare pays for the interpretation of diagnostic radiology and other diagnostic tests if the interpretation is performed by or reviewed with a teaching physician. If the teaching physician's signature is the only signature on the interpretation, Medicare assumes that he/she is indicating that he/she personally performed the interpretation. If a resident prepares and signs the interpretation, the teaching physician must indicate that he/she has personally reviewed the image and the resident's interpretation and either agrees with it or edits the findings. Medicare does not pay for an interpretation if the teaching physician only countersigns the resident's interpretation.

Claims *must* include GC or GE modifiers for services involving Residents:

B . Billing Modifiers

Effective January 1, 1997, services furnished by teaching physicians involving a resident in the care of their patients must be identified as such on the claim. To be payable, claims for services furnished by teaching physicians involving a resident must comply with the requirements in sections 100.1 through 100.1.6 of this chapter, as applicable. Claims for services meeting these requirements must show either the GC or GE modifier as appropriate and described below.

1. Teaching Physician Services that Meet the Requirement for Presence During the Key/Critical Portion of the Service

Claims for teaching physician services in compliance with the requirements outlined in sections 100.1 -100.1.6 of this chapter must include a GC modifier for each service, unless the service is furnished under the primary care center exception described in section 100.1.1C (refer to number 2, below). When a physician (or other appropriate billing provider) places the GC modifier on the claim, he/she is certifying that the teaching physician was present during the key/critical portion of the service, and was immediately available during the other parts of the service.

2. Teaching Physician Services Under the Exception for E/M Services Furnished in Primary Care Centers

Teaching physicians who meet the requirements in section 100.1.1C of this chapter must provide their contractor with an attestation that they meet the requirements. Claims for services furnished by teaching physicians under the primary care center exception must include the GE modifier on the claim for each service furnished under the primary care center exception.

This message is intended for the Gainesville practice.

Questions?

Contact the Office of Physician Billing Compliance for the University of Florida, College of Medicine, Gainesville Campus
Phone: (352) 265-8359 or e-mail: nwt@ufl.edu

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