Hospitalist Medicine Coding:

Hospitalist medicine is one of the fastest growing specialties in the United States. Medical coding for hospitalized patients is challenging as they tend to have more complex conditions than those treated by practitioners in other specialties, including outpatients. The Centres for Medicare & Medicaid Services (CMS) recently granted a new dedicated billing code for hospitalists, an important step in the recognition of this specialty.

Billing for Hospitalists:

All the services performed cannot be billed for, hospitalists can and should document and code appropriate levels of service to ensure appropriate reimbursement. Here are some important points to note:

  • In the inpatient hospital setting, CPT codes Inpatient hospital visits should be used to report initial hospital care, per day, for the evaluation and management of the patient. Hospitalists need to ensure thorough documentation. Failing to provide comprehensive documentation will result in down coding of initial hospital care.
  • CPT codes Inpatient hospital visits should be used to document all levels of subsequent hospital care that includes review of the medical record, review of diagnostic studies, and changes in the patient’s status since the last assessment
  • Knowledge about state-specific Medicare rules is crucial to obtain maximum reimbursement. For instance, Medicare reimbursement for a Level Three initial visit is different from a Level One hospital admission and the amounts vary among states.
  • Use the right hospital discharge services codes and hospital observation services codes. The admitting physician can bill hospital observation codes to report E/M services when physicians order observation services for patients.
  • For assignment of the right ICD-10 diagnostic codes, it is crucial for the physician to document the diagnosis clearly. Also, when the patient’s condition is documented, specificity is crucial. For instance, when assessing pain, it is important to state whether it is chronic or acute, and whether it is neuropathic, visceral, or somatic.
  • The provider should clearly state the problem treated. In a hospital setting, many physicians may be involved in the treatment of the patient and therefore hospitalists should clearly report the specific condition they are treating. They should also report their own review of lab data or radiology reports.