The teaching physician rules are Medicare rules that allow for payment for combined services that are performed between an intern, a resident or a resident-fellow, and a licensed attending physician (the teaching physician).

This Teaching Physician Coding Guide will provide you with how the following factors may differ based upon the type of medical service provided:

• The level of participation,
• who must document the participation and
• the required documentation

This coding guide starts with a quick reference sheet to help you, because whatever the medical service, there must be documentation of the attending’s participation in the care of the patient. This is an area of high compliance risk and academic practices need to educate and re-educate with every new group of residents and recently hired attending physician.

To emphasize the importance, CMS announced a recent audit run by a private contractor to make sure the teaching physicians are not over-reporting the “use” of these learners. You can learn more about it in the Teaching Physician Guide.[1]

The Medicare Online manual,[2] as well as the Teaching Physician Guide have specific definitions related to the teaching physician rule which we will introduce.  The two publications we reference should be next up on your reading list! (After this guide, of course.)

Table of Contents

• Quick reference sheet
• Teaching physician rules
• Change relating to medical student services
• E/M services
• Primary care exception
• Telehealth
• Surgical services
• Modifiers
• Critical care
• Psychiatry servcies
• CMS resources

For additional resources, see teaching physician articles and tips which include a quick reference reference sheet, and

Review the complete Medicare Guidelines

[1] https://www.cms.gov/files/document/guidelines-teaching-physicians-interns-residents.pdf

[2] https://www.cms.govƒG/Regulations-and Guidance/Guidance/Manuals/Downloads/clm104c12.pdf