decisionhealth Newsletters, Coder Pink Sheets - 2009 Issue 3 (March)
Understanding E/M: Medicare’s split/shared service rules don’t apply to residents
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Article Overview
This premium article discusses Medicare guidance on evaluation and management payment policies, focusing on why split/shared service rules do not apply in the same way when residents are involved in teaching physician scenarios. It also addresses broader physician-to-physician sharing of E/M services in office and hospital settings, including documentation considerations and the role of CMS guidance. The content is most relevant to coders, billing staff, compliance teams, and physicians working in teaching and group practice environments.
Why This Topic Matters
Correctly distinguishing teaching physician rules from split/shared E/M policies helps avoid billing and documentation errors in settings where residents or multiple physicians participate in patient care. The article is useful for organizations that need to align E/M reporting practices with Medicare guidance.
Article Sections
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Split/shared E/M policy and teaching physician rules
Introduces the Medicare policy distinction between split/shared evaluation and management services and resident involvement under teaching physician rules. The section frames the topic using CMS guidance and clarifies the general policy context.
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Physicians sharing E/M services
Describes Medicare’s broader approach when physicians in the same group share patient care across office and hospital settings. The section discusses general reporting considerations and documentation expectations for shared E/M encounters.
What You Will Learn
- How Medicare separates split/shared E/M policy from teaching physician scenarios
- What general CMS guidance says about residents participating in E/M services
- How shared physician visits are treated in office and hospital settings
- Why documentation matters when multiple physicians contribute to an E/M encounter
Who Should Read This
- Medical coders
- Billing staff
- Compliance teams
- Physicians
- Teaching hospitals
- Practice administrators
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