First Six Month of Training

Medicare/Medicaid GC

Must supervise and have physical presence by Teaching Physician – Teaching Physician must perform the substantive part of the physical exam or be present during the substantive part of your physical exam. Resident must document the HPI, ROS, PE, Diagnosis and Treatment Plan (SOAP). This should be completed before the end of that clinic session.

Teaching Physician documents involvement with case according to Teaching Physician guidelines.

Second Six Months of Training

Medicaid GC

Must supervise and have physical presence by Teaching Physician – Teaching Physician must perform the substantive part of the physical exam or be present during the substantive part of your physical exam. See GC under first six months above for documentation & teaching physician involvement.

Medicare GE

Does NOT require physical presence by Teaching Physician if one of the following codes:

Established Patients: 99212 Prob Focused, 99213 Expanded

New Patients: 99210 Prob Focused, 99202 Expanded, 99203 Detailed

Resident would document note as if for GC (see above) but Teaching Physician need not perform physical exam. Teaching Physician documents involvement SAP, not SOAP.

Medicare GC

ALL Levels of service other than those listed as exceptions above for the GE modifier require physical presence by the teaching physician and require that the Teaching Physician perform a physical exam or be present during the key portions of the exam performed by the resident. Teaching Physician documents SOAP.

PGY 1’s for all Other Insurance

All cases are discussed with the Teaching Physician; physical presence is at the discretion of the Teaching Physician but signature and date is all that is required.

PGY 2’s & 3’s

GE Physical Presence by the Teaching Physician not required – Types of Visits that Qualify:

Medicare:

Established Patients: 99212 Prob Focused, 99213 Expanded

New Patients: 99201 Prob Focused, 99202 Expanded, 99203 Detailed

Medicaid:

E&M Codes 99212, 99213, 99201, 99202, 99203 (see above)

Well-Child Codes: 99391, 99392, 99393, 99394

See below regarding prenatal visits

Resident’s portion, i.e., the HPI, ROS, PE, Diagnosis and Treatment Plan, should be discussed with Teaching Physician.

Teaching Physician:

Physical Presence not required, SAP note, not SOAP

GC Physical Presence by the Teaching Physician required – Types of Visits that Qualify:

Medicare & Medicaid:

All levels of service other than those listed as exceptions for the GE modifier require physical presence by the teaching physician and require that the Teaching Physician perform a physical exam or be present during the key portions of the exam performed by the resident.

Resident’s portion,

i.e., the HPI, ROS, PE, Diagnosis and Treatment Plan, should be completed before discussing case with Teaching Physician.

Teaching Physician:

Physical Presence required, document a SOAP note.

EXCEPTION for PRENATAL VISITS
Code 59420 prenatal visits for Public Aid only:

• Physical Presence in not required by the Teaching Physician; however, the Teaching Physician will use their discretion to decide if this needs to occur.
• Resident must complete flow sheet and routine exam, discuss with Teaching Physician, sign and date.
• The only documentation required by the Teaching Physician is their signature and date on the prenatal flow sheet form.

NOTE: If the patient comes in at another time other than their regular prenatal visit, you must adhere to the guidelines for GC & GE, and the physical presence and documentation requirements for E&M codes.

GPY 2’s & 3’s -- Other Insurance & Managed Care

All other cases should be discussed with the TP before the patient leaves the clinic. Physical presence is at the discretion of the teaching physician. The only absolute requirement is that the TP sign and dates the resident’s note.