Medical Coding and Billing for Hospitalists – Key Points

by | Published on Apr 6, 2016 | Medical Coding

Medical Coding Billing
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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 Centers for Medicare & Medicaid Services (CMS) recently granted a new dedicated billing code for hospitalists, an important step in the recognition of this specialty.

Coding accurately for hospitalist medicine requires:

  • Knowledge of the various subspecialties of internal medicine
  • Comprehensive understanding of the wide range of conditions and related treatments, and the complications that might occur and/or typical comorbidities

Hospitalists coordinate with primary care physicians (PCPs) to provide proper care. When a patient is admitted to a hospital, the hospitalist examines the patient, reviews history and medications, documents the admission, provides counseling and performs other related tasks related to the admission that the referring PCP would have to handle.

Ensure Proper Documentation to Maximize Reimbursement

While 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 99221-99223 should be used to report initial hospital care, per day, for the evaluation and management of the patient. Hospitalists need to ensure thorough documentation of the initial hospital visit, which includes history, physical examination, and medical decision-making. Failing to provide comprehensive documentation will result in down coding of initial hospital care.
  • CPT codes 99231-99233 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 (for instance, changes in physical condition and response to treatment).
  • 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.
  • 99217: Observation care discharge day management (all services provided to a patient on discharge from “observation status”)
  • 99218–99220: all E/M services physicians render to patients in observation
  • 99238: Hospital discharge day management – 30 minutes or less
  • 99239: Hospital discharge day management – more than 30 minutes
  • 99234-99236: for patients in observation and for inpatients admitted and discharged the same day
  • 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.
  • Correct documentation of critical-care time is necessary. Critical-care time refers to the bedside time and time spent on the patient’s unit/floor where the physician’s services are immediately available to the patient. If the patient becomes critical on the same day for which the provider reports an E/M service, the physician should report the E/M hospital visit and also the appropriate critical care code.

Opt for Professional Medical Coding Services

Partnering with a reliable HIPAA-compliant medical coding company can ensure proper documentation and assignment of accurate CPT and ICD-10 codes. Professional service providers have American Academy of Professional Coders (AAPC) certified coders to review and validate health care documents and assign accurate diagnosis codes, procedure codes and modifiers. They would provide internal audit services to see if hospitalists’ documentation meets the selected evaluation management codes. Opting to outsource medical coding to a reliable service provider would help prevent denials and ensure accurate claim submission for maximum reimbursement.

Rajeev Rajagopal

Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.

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