ED Coding & Reimbursement Alert - 2009 Issue 9
You Be the Coder: Critical Care Involving a Resident
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Article Overview
This Q&A article explains how critical care documentation is reviewed when a teaching physician and resident both participate in patient care. It focuses on the general documentation elements expected in teaching physician claims, the treatment of resident involvement, and the distinction between critical care time and separately billable services. It is aimed at coders, billers, compliance staff, and physician practices that submit teaching physician claims.
Why This Topic Matters
Teaching physician claims often depend on precise documentation, and resident involvement can affect whether critical care time is reportable. Understanding the article helps practices recognize the broad documentation themes that support compliant reporting without relying on resident time or other non-countable activities.
Article Sections
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Question
The scenario presents a teaching physician, a resident, and a patient requiring critical care, along with a question about whether the service can be reported when a resident is involved.
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Answer
The response addresses the overall ability to report the service and ties that to documentation support and teaching physician participation.
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Key questions
This section outlines the general documentation themes to review in teaching physician claims involving critical care, including supervision, joint treatment, and resident note reference.
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Tip
This section discusses resident-performed procedures, credentialing considerations, and how such services relate to billing under an individual provider.
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Also remember
This section explains the distinction between critical care time, teaching time, and time spent on separately billable procedures.
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Good practice
This closing guidance encourages documentation of the time spent on critical care while excluding non-countable activities.
What You Will Learn
- How teaching physician documentation is evaluated in a critical care scenario
- How resident involvement affects the discussion of reportable critical care services
- Which broad documentation elements are emphasized for teaching physician claims
- How critical care time is distinguished from teaching time and other non-countable time
- How separately billable services are treated in relation to critical care reporting
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Physician practices
- Teaching physicians
Codes Discussed
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