Physicians at Teaching Hospitals guidelines for billing procedures are far less complex than those required for billing evaluation and management services. Guidelines specify that when a procedure is performed by a resident, teaching physician attendance and participation are required and must be documented. The level of participation required by the teaching physician depends on the type of procedure being performed. A resident, nurse, or teaching physician may document the teaching physician's attendance. The following is a summary of the rules and documentation tips. The rules for supervising physicians in teaching settings can be obtained on the Centers for Medicare & Medicaid Web site at http://cms.hhs.gov/manuals/downloads/clm104c12.pdf, section 100.

The CMS defines a minor procedure as one taking 5 minutes or less to complete with relatively little decision-making once the need for the procedure is determined. They are also usually assigned a 0- to 10-day global period. Teaching physicians may bill...

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