Billing for Emergency Medicine
                        ==============================

þ Examples of Acceptable Documentation (UPP 8/08) 
 - Admitting note: 
   "I performed a history & physical exam of the patient and discussed the 
   management with the resident. I reviewed the resident's note and agree with 
   the documented findings and the plan of care." 
 - Follow Up visit: 
   "See resident's note for details, I saw and examined the patient and agree 
   with the resident's findings and plans as written."

HCFA Billing Guidelines:                <HCFAACEP.TXT>

þ Guidelines for including presenting signs and symptoms to ED
  (in PA, state law requires as of Jan 1 1997 that these be taken in account
  for payment for ED visits):
 - acute abdominal pain --      ovarian cyst/
                                constipation
                                cystitis
                                PID
 - hyperpyrexia --              viral syndrome
                                fever w/o source
   [< 3 months, >=38
    2-23 months, >=39
    > 24 months, >= 40
 - choking
   dyspnea
   respiratory abnormality --   URI
 - altered mental status/
   altered level of             excessive crying
   consciousness --             irritability
 - scrotal pain --              orchitis
 - chest pain --                costochondritis
                                pleurodynia
 - hematuria --                 UTI
 (from Bruce Rosenthal, M.D.)

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"Physician Documentation of Services Provided in a Teaching Setting"
presented by PA Blue Shield and Xact Medicare Services,
1/10/97, Mercy Hospital


IL-372: original rules on documentation; basis for HCFA actios against
 Penn and Jefferson
Now, new rules:  audits by PA Blue Shield will start at end of 97.

Blue Cross paymens are Part A, general payments,
 and Blue Shield are Part B payments directly to physicians.

Special outpatient center exception to rules (doesn't apply to the ED)
(gets around physical presence requirement) and only for lower E/M codes.

+ must be source of "continuing care"
+ resident must have completed more than 6 months of training
+ must supervise no more than 4 residents at any one time
+ immediate availability
+ review each visit, before patient leaves clinic
+ attending must document services


Surgery:
+ must be there for key portios
+ must be immediately available: can be documented by resident, nurse or
  attending.

Opinion offered by representative that length and complexity of procedure, not
where it occurs; thus, a two-hour laceration repair in the ED would be
considered a major surgery.

Moonlighting by residents:
to bill: fully licensed,