Case and Commentary
Jun 2000

Billing for Services Performed by Another

Faith Lagay, PhD
Virtual Mentor. 2000;2(6):50. doi: 10.1001/virtualmentor.2000.2.6.hlaw1-0006.


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.

Question for Discussion

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 1998-1999 Edition. Chicago, IL: American Medical Association; 1998.


Virtual Mentor. 2000;2(6):50.



The people and events in this case are fictional. Resemblance to real events or to names of people, living or dead, is entirely coincidental. The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.