teaching physicians/residents

Would like to survey participants who practice in a teaching facility. resident performs G0101, no faculty present. Or; resident performs G0101, faculty supervises but not in room. Billing policy?
Thanks

re: teaching physicians/residents

[Would like to survey participants who practice in a teaching facility. resident performs G0101, no faculty present. Or; resident performs G0101, faculty supervises but not in room. Billing policy?
Thanks]
That's an interesting question, Nancy.

We know that G0101 is not one of the allowed codes under the primary care exception rule, so it doesn't fall there. (Unless the Welcome to Medicare and AWV.)

Are we going to call it an E/M service or a procedure? Do you know off hand how it's listed in the MFS?

re: teaching physicians/residents

G0101 is an Active code on the fee schedule. It is not listed as exception rule. It is really a physical of the stated areas for screening purpose. It is stated in IOM that a physician or Osteopath: 40.1 - Screening Pelvic Examinations
B3-4603.2.A, B3-4603.5, A3-3628.1.B.1, R1888.A.3 Dated 6-3-2003
The following requirements must be met.
The exam must be performed by a doctor of medicine or osteopathy (as defined in
§1861(r)(1) of the Act), or by a certified nurse midwife (as defined in §1861(gg) of the
Act), or a physician assistant, nurse practitioner, or clinical nurse specialist (as defined in §1861(aa) of the Act) who is authorized under State law to perform the examination. This examination does not have to be ordered by a physician or other authorized practitioner. I do not consider it a procedure in strict sense of the word.

re: teaching physicians/residents

Nancy, if you don't know the answer, none of us have a chance! :)

G0101 is most like an E/M service, in my opinion, can't be billed using the Primary Care Exception rule, isn't a procedure, so I think the TP rules that apply would be the ones about E/M services. In order to bill for an E/M service performed jointly with the resident, the physician would need to see and examine the patient, so if resident and attending just "discussed" I would not say it is reportable by the attending.

If the TP was in the room, even if the TP didn't perform the elements of the exam, I think you could bill it.

What do you think?

I looked quickly at Section 100 of Chapter 12 and didn't find anything specific.

re: teaching physicians/residents

I think it could be part of AWE or IPPE and the supervising would follow exemption rules.
Otherwise if done as GC, teaching/resident service. the attending would have to have a face-face during some of exam, critical portion, which is crazy might as well do exam himself.
If only resident does the service, cannot be billed.
Nancy

re: teaching physicians/residents

The AWE and the IPPE have been added as GE exemptions along with 99201-99203 or 99211-99213.

re: teaching physicians/residents

An example of a GC encounter where G0101 is done would be a preventive exam. Medicare allows the breast and pelvic exam o be carved out of preventive because they do not cover preventive codes in CPT®. In this case for the faculty member, he/she would have to be present during the critical portion, face-face and immediately available during the encounter. The attestation must confirm the hands-on face-face by faculty and a discussion with resident about findings and plan.
private payers consider the breast and pelvic exam included in the preventive codes.