Strategies for Reporting E/M Services & Minor Surgical Procedures Using TP RULES

Want to ensure your ob-gyn gets paid for E/M services and minor surgical procedures performed in a teaching setting? Well you can ensure it so long as you know the requirements for Medicare's teaching physician rules.

Here are some sure-fire strategies for reporting E/M services and minor surgical procedures using the teaching physician rules.

a) You should report outpatient services based on 'key portions'. Think that the TP provides an E/M service such as an office visit (99201-99215) without the resident present. The TP may be able to use some of the resident's work under TP guideline.

Here's how: If the resident also carried out the E/M service the TP carried out, your ob-gyn would have to duplicate the 'critical and key portions' of the resident's services to bill under this guideline. The TP should define and be able to defend those critical and key portions.

b) You should ensure resident's presence for evaluations

If the resident didn't attend the TP's patient evaluation and also did not carry out a complete evaluation and management service, the TP must bill and document the office visit as he would in a nonteaching setting. To put it in other words, to support a 99202 claim, the ob-gyn would have to document an expanded problem-focused history, an expanded problem-focused exam, and straightforward medical decision-making.

c) Thirdly, you should document ob-gyn presence for critical care. Documentation requirements for the claims are high however an ob-gyn can also code when he and the resident perform critical care jointly.

d) You should also let supervision guide surgical claims. When you report minor surgeries and endoscopic procedures, you should ensure the ob-gyn documents that he directly supervised the entire procedure. That means the physician must be present in the room. For instance, he cannot view the session through a monitor in another room.

e) You should keep the primary-care exception in mind. If your ob-gyn is also treating a primary-care clinic patient, you might be able to use the primary-care exception rule.

To put it in a nutshell, Medicare allows a TP to get paid when a resident provides an E/M service without the TP's direct supervision. These cases must fall under the MCM's primary-care exception, which refers to E/M new patient codes 99201-99203 and established patient codes 99211-99213.

For further details on which modifier to use for primary care exception and for other ob-gyn coding updates, sign up for a one-stop medical coding guide like Supercoder.com "http://www.supercoder.com"