Billing for Resident Services

March 1, 2007

We have a surgical resident in our practice. Our surgeon sent him to the hospital to do a simple I&D bedside, and then the surgeon went after hours to see the patient at the hospital. How do we bill for this service? Do we bill as if the surgeon had performed the service?

Question: We have a surgical resident in our practice. Our surgeon sent him to the hospital to do a simple I&D bedside, and then the surgeon went after hours to see the patient at the hospital. How do we bill for this service? Do we bill as if the surgeon had performed the service?

Answer: According to expert biller Betsy Nicoletti, “The teaching physician rules say that for a minor procedure (less than five minutes), the supervising physician must be there for the entire procedure in order to bill it as if the attending physician had performed the service.”

Here’s the citation from the IOM Medicare Claims Processing Manual, Pub 100-04, Chapter 12, Section 100.1.2 B:

“Minor Procedures: For procedures that take only a few minutes (five minutes or less) to complete, e.g., simple suture, and involve relatively little decision making once the need for the operation is determined, the teaching surgeon must be present for the entire procedure in order to bill for the procedure.”