Teaching physician rules for psychiatry

Psychiatrists use two distinct sets of codes, and so must know two sets of teaching physician rules: the rules for Evaluation and Management (E/M) services (admissions, rounds, established patient office/outpatient visit) and the rules for Psychiatry codes, such as psychiatric diagnostic evaluation and psychotherapy.  The previous blog on this site describes the teaching physician rules for E/M services.  This post will describe the teaching physician rules for using the Psychiatry codes.


The Medicare Claims Processing Manual states that the general rules described in the previous section applies to psychiatry.  That is, in order to bill for a service the attending must be present for or personally perform at a separate visit the key components of the service.  The attending must see the patient, participate in the treatment plan and personally document his/her participation in the care.  Supervision and case conference alone is insufficient for an attending physician to report Psychiatry services performed by a Psychiatric resident. 


However, for some psychiatry codes, concurrent observation may be substituted.  The rules say, “The general teaching physician policy set forth in §100.1 applies to psychiatric services. For certain psychiatric services, the requirement for the presence of the teaching physician during the service may be met by concurrent observation of the service by use of a one-way mirror or video equipment. Audio-only equipment does not satisfy to the physical presence requirement.”

Only a physician, not a psychologist, may supervise and report the services of a resident under the teaching physician rules.

For codes selected on the basis of time, such as psychotherapy, only the teaching physician’s time may be counted toward reporting the code.  Do not add together the resident’s time and attending’s time.

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