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Pediatric Neurology Inpatient consult time billing and TP

Luz Posted Tue 05th of May, 2015 09:19:45 AM

I need your opinion on the following question that was prompted by one or our physician from the pediatric department. They do inpatient consultation especially the ICU and they spend a lot of time in there with counseling and coordination of the neurologic care. Because of the amount of time that they spend with the patients and family they want to bill based on counseling and/or coordination of care. However, the services are done with residents and according to the TP guidelines, the resident time along with the patient is not counted unless the resident is with TP performing the service. They want to do a linking statement for the resident participation and also another statement regarding the time spend in counseling and coordination of care. I really need your expertise in answering this question due to the fact that is a teaching physician scenario and I am not sure if this is allowed.

Your input is appreciated

SuperCoder Answered Wed 06th of May, 2015 03:12:58 AM

The services of the resident are not payable until and unless there is involvement of the teaching physician. Services are payable when:
The resident performs the elements required for an E/M service in the presence of, or jointly with, the Teaching Physician and the resident documents the service. In this case, the Teaching Physician must document that he or she was present during the performance of the critical or key portion(s) of the service and that he or she was directly involved in the management of the patient. The Teaching Physician’s note should reference the resident’s note. For payment, the composite of the Teaching Physician’s entry and the resident’s entry together must support the medical necessity and the level of the service billed by the Teaching Physician.
2. If the resident performs some or all of the required elements of the service in the absence of the Teaching Physician and documents his or her service. The Teaching Physician independently performs the critical or key portion(s) of the service with or without the resident present and, as appropriate, discusses the case with the resident. In this instance, the Teaching Physician must document that he or she personally saw the patient, personally performed critical or key portions of the service, and participated in the management of the patient. The Teaching Physician’s note should reference the resident’s note. 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

SuperCoder Answered Wed 06th of May, 2015 03:18:26 AM

In an inpatient setting, when more than 50% of the total visit time by the teaching physician is counseling and/or coordinating the patient’s care, the time used to code must be provided at the patient’s bedside and/or on the patient’s hospital floor or unit.
When coding based on time, the teaching physician may not:
Add time spent by the resident in the absence of teaching physician to face-to-face time spent with the patient by the teaching physician with or without the resident present.
Count time counseling or coordinating the patient’s care after leaving the patient’s floor or after beginning to care for another patient.

Luz Posted Wed 06th of May, 2015 14:58:13 PM

The second part answer my question. I am assuming that a linking statement is not required when the teaching physician is not counting the resident's time because the resident was not present.

SuperCoder Answered Thu 07th of May, 2015 02:50:42 AM

No, it is not required. It is a general rule that states if a resident participates in a service provided in a teaching setting, the teaching physician may not bill Medicare Part B for services unless the Teaching Physician is present during, or personally performs, the key portion of any service for which payment is sought.

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