TP - Teaching provider (MD, CSW, Clin Psy.) either personally performed or jointly provided service with auxiliary provider (PA, NP, RN, etc.) Zero percent resident/fellow participation in ANY part of the service. (Billed to all insurers)
FR - Teaching Physician service provided in ANY part by resident/fellow. MEDICARE TEACHING PHYSICIAN GUIDELINES MET AND DOCUMENTED. (Billed to all insurers) AP - Attending/Teaching Physician service provided in ANY part by resident/fellow where Medicare Guidelines NOT completely met and/or NOT completely documented, BUT teaching physician did examine patient, confirm diagnosis, etc. (Billed to all insurers except Medicare) DM - Teaching Physician directed a resident/fellow service while immediately available or designated on call. FR, AP, or PC not appropriate for this service. (Billed to all insurers except Medicare Tricare/Champus) PC - Teaching physician present in the Primary Care Clinic rendered a professional service under the Medicare Primary Care Exception. (Billed to all insurers) GS - Service by any provider specialty that is part of a surgeon's 'normal' global fee. (Billed to all insurers except Medicare, Medicaid and Tricare/Champus) I2 - Service rendered solely by non-physician practitioner (PA, NP, RN, etc. NOT a resident/fellow/medical student) that is 'incident to' (I2) a teaching physician: 1. NOT employed by the hospital, 2. Performed under the course of treatment initiated by a teaching provider, AND 3. A teaching provider was present in the patient care area to provide direct supervision. Outpatient setting only (Used by non-physician practitioners only.) WP - Service rendered solely by non-physician practitioner that is NOT provided 'incident to' a teaching provider, meaning one or more of the following: 1. Employed by the hospital, AND/OR 2. No course of treatment previously initiated, AND/OR 3. No direct supervision by a teaching provider. (Used by non-physician practitioners only. Billed in extender's name to Medicare and physician's name to all other insurers.) RG - Grant specific service or order which was performed because of a research protocol, or which is only to be billed to a Research Grant. (Billed to Research Grant only) MN - Medically necessary service that is performed regardless of any clinical trial/research (i.e., this service is normal/conventional care) and all other applicable Medicare requirements are met (i.e., Medicare Teaching, Physician Guidelines and 'Incident to' requirements.) (Billed to all insurers) |