Teaching Physician – A physician (other than another resident) who involves residents in the care of his or her patients.

Resident – An individual who participates in an approved graduate medical education (GME) program or a physician who is not in an approved GME program but who is authorized to practice only in a hospital setting.  The term includes interns and fellows in GME programs recognized as approved for purposes of direct GME payments made by the Fiscal Intermediary.  Receiving a staff or faculty appointment or participating in a fellowship does not by itself alter the status of “resident”.  Additionally, this status remains unaffected regardless of whether a hospital includes the physician in its full time equivalency count of residents.

Physically Present – The teaching physician is located in the same room (or partitioned or curtained area, if the room is subdivided to accommodate multiple patients) as the patient and/or performs a face-to-face service.

STANDARD

In order to bill for endoscopic procedures, the teaching physician must be present during the entire viewing. Entire viewing includes insertion and removal of the device.  The Teaching Physician’s presence may be demonstrated by notes made by the Teaching Physician, Resident, or Nursing Staff.

Viewing this procedure in another room via monitor does not meet the physical presence requirement.

The teaching physician must be in a position where he/she can influence the process.

The teaching physician must include in the documentation a notation that states he/she observed the endoscopy.

1. A sample documentation for this type of procedure would be “I was present during the entire viewing, from the insertion of the scope until it was withdrawn and have reviewed the findings with Dr. … (resident) and concur with the treatment plan of…”

REGULATORY REFERENCES

Medicare Claims Processing (PUB. 100-04)
Chapter 12 – Physicians/Nonphysician Practitioners
100 – Teaching Physician Services (Updated through Rev. 2303 **Rescinds and Replaces Transmittal #2247, dated 06/24/11**; Effective: 06/01/11; Issued: 09/14/11)

QUESTIONS

Questions regarding policies, procedures or interpretations should be directed to the USC Office of Culture, Ethics and Compliance at (323) 442-8588 or USC Report & Response at (213) 740-2500 or (800) 348-7454.