Teaching Physician Supervision

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Teaching Physician Supervision Documentation
Guidelines

• 12/20/2001
• Presented by
• Susan Magdall, CPC, CHC
• Institutional Compliance Program

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Teaching Supervision Rulesapply to

• Medicare patients only
• Supervision of residents

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Documentation Issues..

• Is the documentation legible?
• Did the physician sign, date, and time the note?
• Did the teaching physician document a proper
• linking statement/note to show his/her personal
• presence if a resident was involved ?
• Does the documentation support billing for the
• service being provided?

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Different E/M Scenarios

• Physician sees the patient alone
• Physician sees the patient jointly with the
  resident
• Resident sees the patient first followed by
  the faculty

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Proper linking statements
Stand alone note I personally interviewed and
examined Teaching physician sees patient
jointly with the resident I personally saw the
patient along with Dr. Resident
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Proper linking statements
Resident sees the patient first followed by the
teaching physician Today I saw the patient in
the hospital. I have reviewed the history with
Dr. Resident and agree with the diagnosis of
Pneumonia. Patient still complains of shortness
of breath. On my examination there are still
crackles in the lower left base. Will obtain
chest x-ray, CBC, and initiate erythromycin.
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Things to remember

• Linking statement alone is not sufficient
• The physician must confirm, revise, or add
  to residents findings

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How do you know if the attestation is sufficient?

• Make sure the teaching physician uses personal
  pronouns such as I.
• The documentation must clearly state the presence
  and the involvement of the teaching physician
  with the resident.
• If the physical exam is not performed in the
  presence of the faculty, they must repeat the key
  portion.

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Example 1
Teaching Physician sees the patient along with
the Resident Proper tie in statement I
personally interviewed and examined the patient
along with Dr. Resident. The patient did not
have a history of back pain prior to MVA. I
examined the patient and found the lumbar spine
and range of motion to be normal. There is no
edema. I agree with the diagnosis of low back
pain and the treatment plan of 600 mg of
Ibuprofen tid. I have instructed the patient to
come back in 2 weeks- sooner if no improvement
within 3 4 days. Dr. Teaching Physician
12/20/01 9am
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Example 2
Teaching Physician sees the patient after the
Resident
Proper tie in statement I personally
interviewed and examined the patient. I reviewed
and agree with Dr. Residents history of watery
eyes for the past week. HEENT Both ears have
fluid, there is clear drainage from the nose, and
the lymph nodes are supple. I agree with the
diagnosis of allergic rhinitis. I recommend
Nasacort AQ once a day in each nostril and to
continue Claritin D. Follow-up in two weeks if
symptoms persist. Dr. Teaching Physician,
12/14/01 10 am
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HAPPY HOLIDAYS!