Forum - Questions & Answers

Aug 1st, 2014 - janeanderson 9 

Patient Leaves Hospital Prior to Attending Physician Seeing Patient

I'm hoping someone can help with a conflict between my co-workers and myself. I work in a teaching environment and below are a couple of scenarios that there are different opinions on how to handle:

Scenario #1:
A resident/fellow sees a patient as an inpt subsequent visit and the patient leaves the hospital for whatever reason, AMA, etc. prior to the attending physician seeing the patient.

Can the Attending physician report an e/m service?

Scenario #2:
A resident/fellow sees a patient as an inpt subsequent visit and during the exam it is determined that the patient can be discharged home today. The patient leaves the hospital prior to the attending physician seeing the patient. The attending physician reviews the patient's chart, completes the discharge summary.

Can the attending physician report a discharge service?

My co-workers are saying yes the attending can billed an e/m service because the inpatient visits can also be based on time spent on the floor/unit reviewing med records, lab results, etc. I think that both of these scenarios are non-billable services because the attending physician did not have a face-to-face encounter with the patient that day and therefore cannot attest to the resident/fellow's findings as documented in the medical record.

Any advice/guideance would be greatly appreciated so that we can all be on the same page.

Thanks in advance,
Jane

Aug 1st, 2014 - Townsend 5 

re: Patient Leaves Hospital Prior to Attending Physician Seeing Patient

This is from CMS Claims Processing Manual:

"For purposes of payment, E/M services billed by teaching physicians require that they personally document at least the following: That they performed the service or were physically present during the key or critical portions of the service when performed by the resident; and The participation of the teaching physician in the management of the patient."

"Where a resident has written notes, the teaching physician’s note may reference the resident’s note. The teaching physician must document that he/she performed the critical or key portion(s) of the service, and that he/she was directly involved in the management of the patient. 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."

Going by this if the teaching physician was not present or participated in the management of the patient, then it is not a billable service. This is the guidance that we follow here. I hope it helps!

Aug 1st, 2014 - janeanderson 9 

re: Patient Leaves Hospital Prior to Attending Physician Seeing Patient

Thank you, that's the information I'd used to base my findings that these types of services are non-billable.

Aug 1st, 2014 - Townsend 5 

re: Patient Leaves Hospital Prior to Attending Physician Seeing Patient

You're welcome. Your co-workers are partially right; however they left out the very important fact that a teaching physician does have to have a face-to-face visit with the patient. One thing we ask here is "How do you know that the resident got the patient's assessment correct if you never saw the patient?" The resident could have missed a vital finding that could have resulted in a different outcome for the patient.



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