Attending Physician

Key facts

Claim field

Attending provider NPI on institutional (UB-04 or 837I) claims

Teaching physician billing

42 CFR 415.172 (presence during critical or key portions)

Hospice definition

42 CFR 418.3 (physician, NP or PA identified by the patient)

What is an attending physician?

In a hospital, the attending physician directs the patient's care: making diagnostic and treatment decisions, writing or approving orders, calling in consultants and deciding when the patient is ready for discharge. Responsibility can pass between attendings during a stay, for example when hospitalists rotate on and off service.

In teaching hospitals, attending means a physician who has completed training, as opposed to residents and fellows. The attending supervises the trainees, carries final responsibility for the patient and bills for the professional services.

How the attending role appears in rules and claims

The term has specific meanings in several settings:

• Hospital claims: institutional claims name an attending provider, the clinician primarily responsible for the care billed, and can also name operating and other providers.
• Teaching physician rules: under 42 CFR 415.172, Medicare pays for services involving residents only when the teaching physician is present for the critical or key portions, subject to exceptions set out in other sections, such as certain primary care services.
• Hospice: Medicare defines the attending physician as the physician, nurse practitioner or physician assistant whom the patient identifies, when electing hospice, as having the most significant role in their medical care.

Why the attending physician matters

The attending field on hospital claims ties an inpatient or outpatient episode to a named clinician, which is how analysts attribute admissions, procedures and outcomes to physicians. Device and hospital drug teams use attending relationships to find the decision makers for inpatient therapies, and utilization studies use them to compare practice patterns across physicians.

Attending physician vs hospitalist vs PCP

A hospitalist is a type of physician who usually serves as the attending during medical hospital stays. A patient's primary care provider (PCP) may never see the patient in the hospital. In claims data, the attending can also be a surgeon or other specialist when the admission is for their procedure.