July 1996 AAOS Report

Teaching physician guidelines released by HCFA

The Health Care Financing Administration recently released its final teaching physician guidelines. The guidelines go into effect July 1, and outline the documentation required in order for a teaching physician to bill Medicare for the services of a resident under his or her supervision. The new guidelines state that in order for a teaching surgeon to bill for a surgical procedure (including endoscopic surgical procedures) performed by a resident, the physician must be present for the "key portion" of the procedure. If the teaching surgeon leaves the operating room after the "key portion," he or she should either be immediately available to return or should arrange for another physician to be available to intervene should the need arise. The guidelines do not define "immediately available" in terms of proximity to the operating room. A teaching surgeon may bill for two overlapping surgeries, but must be present for the "key portion" of both operations. The surgeon must personally document the key portions of both procedures in his or her notes. In the case of three concurrent procedures, the role of the teaching surgeon will be classified as a supervisory service to the hospital, and will not be paid under Medicare Part B. For minor surgical procedures, for example simple suturing, the teaching physician must be present for the entire operation.

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