Over 650 physicians and university employees participated in the Teaching Physician tutorial and quiz. Eighty-three percent of those taking the quiz did so using the interactive quiz on the internet. Detailed instructions on how to access the web-site are included in this newsletter.
The answers to the questions on the Medical and Surgical Quiz are below. The number after each answer reflects the percentage of those who answered the question correctly.
Evaluation and Management Questions
- The three components of an E & M service are the history, examination and medical decision making. 97%
- Medical Decision Making is based on the: 1) number of diagnoses or management options, 2) amount and/or complexity of data to be reviewed and 3) risk of complications and/or morbidity or mortality. 96%
- The key element of "History" is composed of the: Chief Complaint, History of Present Illness (HPI), Review of Systems (ROS) and Past, Family, Social History (PFSH). 93%
- Intra-service time may be a variable that is predictive of the work or level of E & M service and should be supported by the documentation in the medical record. 91%
- For counseling and coordination of care services, time is the key controlling factor to qualify for a particular level of E & M service. 88%
- The Primary Care Exception provides an exception to the rules about teaching physicians presence during key portions of E & M services. 76%
- Physicians may use either the single system exam or the general multi-system exam guidelines. 73%
Documentation Guide
- For initial hospital care, emergency visits, new office visits, office and inpatient consultations, a personal notation must be entered by the teaching physician for all three of the key elements. 97%
- The phrase - "I have read and concur"-is not sufficient documentation of a teaching physician presence when a resident has examined a Medicare patient and written a note relating to patient care. 96%
- Medicare Part B rules require teaching physicians document personal involvement with the service of residents when they provide E & M services to Medicare patients. 95%
- For the interpretations of diagnostic radiology and other diagnostic tests the teaching physician may NOT countersign the resident's interpretation. 90%
- Documenting the status of three or more chronic illness constitutes and extended HPI. 73%
- For initial hospital, new patient office visits, ER and consults, the teaching physician (TP) must personally document the HPI. The TP may refer to the resident's review of systems and past, family and social history. 71%
- For subsequent visits a personal notation by the teaching physician must be entered for 2 of the 3 key elements (history, exam, medical decision making). 64%
Surgery
- Teaching surgeons do not have to be present when their residents open and close surgical cases unless the opening and / or closing are determined to be key elements of the procedure. 88%
- During surgical procedures, immediately available means the physician is not involved in another procedure from which he/she cannot return and is in proximity to the operating room to quickly return. 80%
- The physical presence of the teaching surgeon for post-op visits is required for only the key post-op visits which are determined by the teaching surgeon. 78%
- For single surgeries, the teaching surgeon's presence may be demonstrated by notes in the medical record made by the physician, resident or operating room nurse (surgical roll call). 64%
Teaching Physician Rules
- For radiology and complex or high-risk diagnostic tests, the teaching physician must be personally present during procedure performance. 95%
- The teaching physician (TP) must be present for minor procedures which normally do not exceed 5 minutes to complete. 93%
- For time based codes such as critical care, the TP (teaching physician) cannot include the time spent by residents. 93%
- Under the "Primary Care Exception," the TP must not supervise more than 4 residents who have completed at least 6 months of an approved residency program. 92%
- Teaching physicians are NOT required to see every Medicare patient unless he/she intends to bill for services. 91%
- Services in which residents participate should be billed with modifier "GC" or "GE". 90%
- Teaching physicians may not bill for the services of nurse practitioners and physicians assistants in the same manner in which resident services are billed. 85%
- In order for the teaching physician to bill for minor procedures, such as simple suturing, he or she must be present for the entire procedure. 85%
- To bill for endoscopies, the teaching physician must be present for the entire viewing, including insertion and removal of the device. 81%
- Personal documentation is critical for compliance with new Medicare rules for supervising physicians in teaching settings. The teaching physician must either personally document his / her encounter, examine and question the patient to verify the resident note and add personal documentation or joint visits, personally note his or her confirmation of each component documented by the resident and the teaching physician presence. 77%
The most frequent suggestion we received was that the quiz should be more specialty specific. Based on this, we are adding 18 specialty quizzes to the web site. Quizzes for anesthesiology, cardiology, critical care, ENT, emergency medicine, hematology, internal medicine, neurosurgery, obstetrics and gynecology, ophthalmology, orthopaedics, pathology, pediatrics, psychiatric, pulmonary, radiology, radiation oncology, and surgery will be added in the near future.
Accessing the Web-Site
In order to access the site, you need to click on the Internet icon. This will bring you to the Yale New Haven Medical Center. In the location box, type http://info.med.yale.edu/il372 or http://info.med.yale.edu/compliance and hit ENTER.
Please contact Judy Harris by Email at judy.harris@yale.edu or at 785-3868 with questions.