AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. June 2000, Volume 2, Number 6.

Cases in Law and Ethics

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Billing for Services Performed by Another

An ethical case explores whether it's appropriate for an attending physician to bill for a procedure performed by a resident.

Both ethics and law address norms that govern physicians’ behavior. Many view the law as a baseline for articulating the limits placed on individuals living within society as well as an enabling device to facilitate social relationships. Encompassing as the law may be in some areas of human conduct, in many others it is silent. In the absence of legal norms or prohibitions, physicians often find guidance in the standards arrived at through ethical reasoning.

To guide students through the process of ethical reasoning and to acquaint them with case law, a new case study will appear every 2 to 4 weeks. Students will be given legal and/or ethical opinions to assist their decision-making.

June Case Scenario

Mr. Nelson, who has a history of alcoholic liver disease and esophageal varices, presents complaining of epigastric pain and black, tarry stools for the past 3 days. Dr. Lee, the on-call resident, calls his attending physician, Dr. Franklin, for guidance regarding care of the patient. Dr. Franklin believes that because the resident has completed several gastroenterology rotations and will begin a gastroenterology fellowship next year, he is qualified to perform the esophagogastroduodenoscopy (EGD). Dr. Lee does the EGD and sees gastritis, but no active variceal bleeding. After informing the attending physician of his diagnostic findings, Dr. Franklin decides that the patient can be treated medically with a proton pump inhibitor. However, the attending physician bills for the EGD, even though the resident performed the procedure.

Is it ethical for the attending physician to bill for this procedure?

See what the AMA Code of Medical Ethics says about this topic in Opinion 4.03 Billing for housestaff and student services. American Medical Association. Code of Medical Ethics 2008-2009 Edition. Chicago, IL: American Medical Association; 2008:133.

The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.