Medicare requirements on documenting E/M services by teaching physicians
Exception for evaluation and management (E/M) services in certain primary care centers
Teaching physicians providing E/M services with a graduate medical education (GME) program granted a primary care exception may bill Medicare for lower and mid-level E/M services provided by residents. Effective January 1, 2022, teaching physicians may use only medical decision making (MDM) for purposes of E/M visit level selection when billing the Medicare program under the physician fee schedule for office / outpatient E/M visits via a primary care exception.
Time-based codes
Additional guidelines apply to office / outpatient E/M visit codes for which total time is used for the visit level selection. For purposes of selecting the visit level, only count time spent by the teaching physician performing qualifying activities listed by CPT (with or without direct patient contact on the date of the encounter), including the time the teaching physician is present when a resident is performing such activities.
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