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Teaching Physician-2 procedures

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  • Suzan Hauptman
    The guidelines as noted below state: http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf Two Overlapping Surgeries In order to
    Message 1 of 3 , Nov 6, 2012
      The guidelines as noted below state:
      http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf

      Two Overlapping Surgeries
      In order to bill Medicare for two overlapping surgeries, the teaching surgeon must be present during the critical or key portions of both operations. Therefore, the critical or key portions may not take place at the same time. When all of the key portions of the initial procedure have been completed, the teaching surgeon may begin to become involved in a second procedure. The teaching surgeon must personally document in the medical record that he/she was physically present during the critical or key portion(s) of both procedures. When a teaching physician is not present during non-critical or non-key portions of the procedure and is participating in another surgical procedure, he/she must
      arrange for another qualified surgeon to immediately assist the resident in the other case should the need arise. In the case of three concurrent surgical procedures, the role of the teaching surgeon (but not anesthesiologist) in each of the cases is classified as a supervisory service to the hospital rather than a physician service to an individual patient and is not payable under the physician fee schedule.

      My question is for clarification of the phrase bolded above. Does these mean that from the start of the procedure THROUGH the critical/key portions of the procedure the attending physician must be there. Or does it mean that once the critical/key portions start the attending physician must remain? I have always interpreted to mean the critical/key portions only, not from the start of the case-but I was challenged on this and would like some other opinions.

      An example:
      If the surgery starts at 7:00 am. The opening and the prepping of the area takes from 7:00 am until 7:45 am and is done by the resident. At 7:45 am the critical portions of this particular procedure begins and runs through 9:30 am. At that point the closing is not considered critical, and the resident does that while the attending is immediately available.

      Does the attending have to be there from 7:00 am until 9:30 am or just from 7:45 am until 9:30 am? (Presuming the patient is stable, etc. etc. etc.)

      Can another procedure begin between 7:00 am and 7:45 am if the critical portions of the 2nd procedure begin at 10am and go until 2:00 pm? OR would the second procedure have to start at 9:31 am (after the critical elements of the 1st procedure have concluded)?

      Thank you,

      Suzan Hauptman CPC, CEMC, CEDC
      Manager of Physician Compliance and Auditing
      West Penn Allegheny Health Systems
      2 Allegheny Center, Suite 100
      Piittsburgh, PA 15212
      412-330-4969
      shauptma@...
      412-330-4970 (fax)

      **********************************************************************
      This email and any files transmitted with it are confidential and
      intended solely for the use of the individual or entity to whom they
      are addressed. If you have received this email in error please notify
      the West Penn Allegheny Health System Help Desk at 412 330-4357.
      **********************************************************************



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      This email and any files transmitted with it are confidential and
      intended solely for the use of the individual or entity to whom they
      are addressed. If you have received this email in error please notify
      the West Penn Allegheny Health System Help Desk at 412 330-4357.
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    • Quinten Buechner
      See below in caps Quinten A. Buechner, M.S., M.Div., ACS-FP/GI/PEDS(BAMC), CPC(AAPC), CCP(PHIA), CMSC(PAHCS) President and CEO ProActive Consultants, LLC 1659
      Message 2 of 3 , Nov 6, 2012
        See below in caps



        Quinten A. Buechner, M.S., M.Div.,
        ACS-FP/GI/PEDS(BAMC), CPC(AAPC), CCP(PHIA), CMSC(PAHCS)

        President and CEO

        ProActive Consultants, LLC

        1659 3rd Ave, Cumberland, WI 54829

        E-mail: QuinB@...

        Phone: 715.822.8284

        Cell: 715.307.4448

        Fax: 715.822.8299



        From: CCO-L@yahoogroups.com [mailto:CCO-L@yahoogroups.com] On Behalf Of
        Suzan Hauptman
        Sent: Tuesday, November 06, 2012 9:17 AM
        To: intelicode@...; CCO-L@yahoogroups.com
        Subject: [CCO-L] Teaching Physician-2 procedures





        The guidelines as noted below state: during the critical or key portions of
        both operations. Therefore, the critical or key portions may not take place
        at the same time. When all of the key portions of the initial procedure have
        been completed, the teaching surgeon may begin to become involved in a
        second procedure. The teaching surgeon must personally document in the
        medical record that he/she was physically present during the critical or key
        portion(s) of both procedures. When a teaching physician is not present
        during non-critical or non-key portions of the procedure and is
        participating in another surgical procedure, he/she must
        arrange for another qualified surgeon to immediately assist the resident in
        the other case should the need arise. In the case of three concurrent
        surgical procedures, the role of the teaching surgeon (but not
        anesthesiologist) in each of the cases is classified as a supervisory
        service to the hospital rather than a physician service to an individual
        patient and is not payable under the physician fee schedule.

        My question is for clarification of the phrase bolded above. Does these mean
        that from the start of the procedure THROUGH the critical/key portions of
        the procedure the attending physician must be there. Or does it mean that
        once the critical/key portions start the attending physician must remain? I
        have always interpreted to mean the critical/key portions only, not from the
        start of the case-but I was challenged on this and would like some other
        opinions.

        An example:
        If the surgery starts at 7:00 am. The opening and the prepping of the area
        takes from 7:00 am until 7:45 am and is done by the resident. At 7:45 am the
        critical portions of this particular procedure begins and runs through 9:30
        am. At that point the closing is not considered critical, and the resident
        does that while the attending is immediately available.

        Does the attending have to be there from 7:00 am until 9:30 am or just from
        7:45 am until 9:30 am? ONLY 7:45 to 9(Presuming the patient is stable, etc.
        etc. etc.)

        Can another procedure begin between 7:00 am and 7:45 am YES if the critical
        portions of the 2nd procedure begin at 10am and go until 2:00 pm? OR would
        the second procedure have to start at 9:31 am (after the critical elements
        of the 1st procedure have concluded)? ANSWERS PRESUMING A SURGEON IS
        IMEDIATELY AVAILIABLE

        Thank you,

        Suzan Hauptman CPC, CEMC, CEDC
        Manager of Physician Compliance and Auditing
        West Penn Allegheny Health Systems
        2 Allegheny Center, Suite 100
        Piittsburgh, PA 15212
        412-330-4969
        shauptma@... <mailto:shauptma%40wpahs.org>
        412-330-4970 (fax)

        **********************************************************************
        This email and any files transmitted with it are confidential and
        intended solely for the use of the individual or entity to whom they
        are addressed. If you have received this email in error please notify
        the West Penn Allegheny Health System Help Desk at 412 330-4357.
        **********************************************************************



        **********************************************************************
        This email and any files transmitted with it are confidential and
        intended solely for the use of the individual or entity to whom they
        are addressed. If you have received this email in error please notify
        the West Penn Allegheny Health System Help Desk at 412 330-4357.
        **********************************************************************

        [Non-text portions of this message have been removed]



        _____

        No virus found in this message.
        Checked by AVG - www.avg.com
        Version: 2013.0.2742 / Virus Database: 2617/5877 - Release Date: 11/06/12



        [Non-text portions of this message have been removed]
      • Sue Kozlowski
        The physician has to be readily available meaning he cannot be at another procedure because that makes him not readily available. From: Quinten Buechner
        Message 3 of 3 , Nov 6, 2012
          The physician has to be readily available meaning he cannot be at another procedure because that makes him not readily available.


          From: Quinten Buechner <QuinB@...>
          To: CCO-L@yahoogroups.com
          Sent: Tuesday, November 6, 2012 4:48 PM
          Subject: RE: [CCO-L] Teaching Physician-2 procedures

           
          See below in caps

          Quinten A. Buechner, M.S., M.Div.,
          ACS-FP/GI/PEDS(BAMC), CPC(AAPC), CCP(PHIA), CMSC(PAHCS)

          President and CEO

          ProActive Consultants, LLC

          1659 3rd Ave, Cumberland, WI 54829

          E-mail: mailto:QuinB%40centurytel.net

          Phone: 715.822.8284

          Cell: 715.307.4448

          Fax: 715.822.8299

          From: mailto:CCO-L%40yahoogroups.com [mailto:mailto:CCO-L%40yahoogroups.com] On Behalf Of
          Suzan Hauptman
          Sent: Tuesday, November 06, 2012 9:17 AM
          To: mailto:intelicode%40mail-list.com; mailto:CCO-L%40yahoogroups.com
          Subject: [CCO-L] Teaching Physician-2 procedures

          The guidelines as noted below state: during the critical or key portions of
          both operations. Therefore, the critical or key portions may not take place
          at the same time. When all of the key portions of the initial procedure have
          been completed, the teaching surgeon may begin to become involved in a
          second procedure. The teaching surgeon must personally document in the
          medical record that he/she was physically present during the critical or key
          portion(s) of both procedures. When a teaching physician is not present
          during non-critical or non-key portions of the procedure and is
          participating in another surgical procedure, he/she must
          arrange for another qualified surgeon to immediately assist the resident in
          the other case should the need arise. In the case of three concurrent
          surgical procedures, the role of the teaching surgeon (but not
          anesthesiologist) in each of the cases is classified as a supervisory
          service to the hospital rather than a physician service to an individual
          patient and is not payable under the physician fee schedule.

          My question is for clarification of the phrase bolded above. Does these mean
          that from the start of the procedure THROUGH the critical/key portions of
          the procedure the attending physician must be there. Or does it mean that
          once the critical/key portions start the attending physician must remain? I
          have always interpreted to mean the critical/key portions only, not from the
          start of the case-but I was challenged on this and would like some other
          opinions.

          An example:
          If the surgery starts at 7:00 am. The opening and the prepping of the area
          takes from 7:00 am until 7:45 am and is done by the resident. At 7:45 am the
          critical portions of this particular procedure begins and runs through 9:30
          am. At that point the closing is not considered critical, and the resident
          does that while the attending is immediately available.

          Does the attending have to be there from 7:00 am until 9:30 am or just from
          7:45 am until 9:30 am? ONLY 7:45 to 9(Presuming the patient is stable, etc.
          etc. etc.)

          Can another procedure begin between 7:00 am and 7:45 am YES if the critical
          portions of the 2nd procedure begin at 10am and go until 2:00 pm? OR would
          the second procedure have to start at 9:31 am (after the critical elements
          of the 1st procedure have concluded)? ANSWERS PRESUMING A SURGEON IS
          IMEDIATELY AVAILIABLE

          Thank you,

          Suzan Hauptman CPC, CEMC, CEDC
          Manager of Physician Compliance and Auditing
          West Penn Allegheny Health Systems
          2 Allegheny Center, Suite 100
          Piittsburgh, PA 15212
          412-330-4969
          mailto:shauptma%40wpahs.org <mailto:shauptma%40wpahs.org>
          412-330-4970 (fax)

          **********************************************************************
          This email and any files transmitted with it are confidential and
          intended solely for the use of the individual or entity to whom they
          are addressed. If you have received this email in error please notify
          the West Penn Allegheny Health System Help Desk at 412 330-4357.
          **********************************************************************

          **********************************************************************
          This email and any files transmitted with it are confidential and
          intended solely for the use of the individual or entity to whom they
          are addressed. If you have received this email in error please notify
          the West Penn Allegheny Health System Help Desk at 412 330-4357.
          **********************************************************************

          [Non-text portions of this message have been removed]

          _____

          No virus found in this message.
          Checked by AVG - www.avg.com
          Version: 2013.0.2742 / Virus Database: 2617/5877 - Release Date: 11/06/12

          [Non-text portions of this message have been removed]




          [Non-text portions of this message have been removed]
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