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Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

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Coding Guide – Teaching Physician Rules

The teaching physician rules are Medicare rules that allow for payment for services that are performed jointly between a resident and a licensed attending physician (the teaching physician).

CMS updated the rules regarding student documentation in 2018 and updated the E/M rules in 2019. This guide reflects both sets of changes.

In 2020, CMS updated documentation requirements for nurse practitioner students and physician assistant students. This guide reflects the changes made in 2018, 2019 and 2020 The 2021 Physician Fee Schedule Final Rule clarified that if time is used to select and E/M service, count only the attending physician’s time, not the resident’s time. This clarification was not a change in policy.

The level of participation, who must document the participation, and the required documentation differ based on the type of service that is performed. But 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.

The updated version of this billing guide starts with a quick reference sheet.

The Medicare manual has specific definitions related to the teaching physician rule. At the end of this billing guide, there are two CMS citations for readers who want to read more .

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

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Relevant Search Terms: Medicare rules for teaching physicians, documenting teaching physician services, billing for residents, teaching physician rules

Last revised November 29, 2021 - Betsy Nicoletti
Tags: teaching physician rules

Wondering about the rules for HCC coding?

Wondering what the rules are for HCC coding, and where you can find them? This video answers your questions. The topic is important to medical practices because risk-adjusted diagnosis coding is part of Medicare Advantage contracts, many commercial contracts and Accountable Care Organizations (ACOs). Sign up for our monthly newsletter to download the whitepaper and watch the video.

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Our mission is to provide accurate, comprehensive, up-to-date coding information, allowing medical practices to increase revenue, decrease coding denials and reduce compliance risk. That's what coding knowledge can do.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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