Teaching Physician Rules | Bedside Procedures

Question:

Can an attending bill for a bedside procedure that a resident did without the attending being present? If so, is this billed at 85% like a PA or NP?

If a PA or NP is overseeing a bedside procedure that a resident is preforming how is this billed (no attending is present at the bedside)? Is it billed under the supervising attending or under the PA/NP who is present or in a different way?

Answer:

Neither of these are billable services. Let’s take them one at a time.

First, the teaching physician rules are Medicare rules that allow for payment for services provided jointly by an attending and a resident. The service is billed under the attending’s provider number. There are different rules for E/M services, minor procedures, major procedures, endoscopies, and time-based codes.  There are in-depth articles, and a quick reference guide on this site.

For teaching physician rules only, a minor procedure is one that takes less than 5 minutes to complete. In order to bill for a procedure that takes less than 5 minutes, the attending must be present during the entire procedure. The attending, resident or nurse can document that the attending was present.

For all other surgical procedures, the attending must be present for the key and critical components of the procedure. The attending decides what parts are key or critical. The attending must be available to provide assistance for all of the procedure.

So, if the attending wasn’t present, the attending may not bill. And of course, the resident can’t bill for the service.

As for the second question, NPs and PAs are not considered attending physicians and whether they are supervising or not, they may not bill for services provided jointly with a resident. So, again, no billing.

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