tci ED Coding & Reimbursement Alert - 2005 Issue 6

READER QUESTIONS: Let Physician Hold the 'Key'

Question: We have a patient who presented to the ED with pelvic pain, and we're at a teaching hospital. According to the Medicare teaching physician guidelines, the attending physician must be present for the key portions of the E/M services. Should we consider the pelvic exam a "key portion" for this patient? If the resident performs the pelvic exam, does the attending need to be present, or can she do a GI exam as the key portion of the exam?Pennsylvania Subscriber  Answer: If the patient's chief complaint in the emergency department is pelvic pain, many clinicians would...

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