April 23, 2015

Question:
We are in an academic setting and I have a question about a specific service performed when a resident was involved on a Medicare case. I was reading notes for a patient who presented to the emergency room (ER) and was admitted to the Orthopaedic Attending physician’s service. The notes by the resident in the ER indicate that the Attending Physician was contacted, though the Attending did not see the patient in the ER. The resident documented the findings and discussion with the attending via the telephone; documented specific orders by the Attending for care provided while the patient was in the ER, including the admission to the Orthopaedic Service. The Attending Physician saw the patient the next day and documented the visit. My question is, can I bill for an E&M service for the telephone discussion with the Attending Physician even though the Attending did not see the patient in the ER? The Attending Physician stated that unless something has changed, the discussion with the resident is not a billable service for him.

Answer:
Your physician is correct. First, there have been no changes in Medicare’s Teaching Physician or any billing rules that would allow the physician to report an E&M service when there was no face-to-face service. While the resident appropriately discussed the case with the Attending Physician, there are no services reportable by the Orthopaedic Attending Physician. Your physician will report the initial hospital care codes for the first encounter the following morning. Because the provider is Medicare, you will also append the AI modifier on the appropriate E&M code to indicate that the Orthopaedic Attending Surgeon is the admitting physician. This modifier will be placed in the second modifier field if a more appropriate payment modifier (e.g., decision for surgery modifier) is required.