What is a hospitalist?
Hospitalist is a doctor who cares for patients at a all. They have the same education and training as general care doctor but are specialized in-hospital care. They may also specialize in pediatric medicine, internal medicine, or family medicine.
Medical coding for hospitalized patients is complicated because their diseases tend to be more complex than those handled by practitioners in other fields, including outpatients. The Centre for Medicare & Medicaid Services (CMS) recently approved a new hospitalist billing code, a significant step toward recognizing this profession.
Requirements for Accurate hospitalist medicine coding
Accurate medical billing necessitates:
- Knowledge of internal medicine’s numerous subspecialties.
- Comprehensive understanding of various ailments, related therapies, potential consequences and typical comorbidities.
Guidelines For Proper Hospitalist Medical Billing And Coding
Understanding state-specific Medicare guidelines are critical for maximizing reimbursement. Medicare compensation varies from level to level.
· Maximize reimbursement by ensuring proper documentation.
While hospitalists cannot bill for all treatments provided, they should document and categorize acceptable service levels to guarantee appropriate compensation. Three critical components are included in the initial hospital visit paperwork. Medical decision-making, physical evaluation, and history are among the components. To reduce down-coding, physicians should ensure that patients’ and others’ histories and systems, such as family history, are adequately documented.
· CPT codes 99221-99223 should be used in the inpatient hospital environment to report essential hospital treatment daily for the examination and management of the patient. Hospitalists must ensure that the initial hospital visit is well documented, including the history, physical analysis, and medical decision-making. Failure to submit sufficient documentation will result in first hospital care being down coded.
· All levels of hospital care, such as evaluation of the medical record, review of diagnostic investigations, and changes in the patient’s state after the last assessment, should be documented using CPT codes 99231-99233.
e.g. Changes in physical condition and response to treatment etc.
Cpt codes for hospitalist billing and coding
- CPT Code 99217: The E&M code (99217) indicates work done to discharge a patient from an observation stay. CPT code 99217, Observation Care Discharge Service, should not be recorded when a patient is seen for fewer than 8 hours on the same calendar day.
- CPT Code 99218-99220: This code is related to initial observation care. E&M codes (99218, 99219, and 99220) are used to indicate the patient’s initial hospital observation visit with the admitting physician. When a patient gets observation care for fewer than 8 hours on the same calendar day, the physician should report the Initial Observation Care (99218 – 99220).
- CPT Code 99238: A Hospital Discharge Day Management Service CPT code 99238 is a face-to-face E/M service between the examining physician and the patient within 30 minutes.
- CPT Code 99239: A Hospital Discharge Day Management Service CPT code 99239 is a face-to-face E/M service between the examining physician and the patient for more than 30 minutes.
- CPT Code 99234-99236: These E&M codes (99234 – 99236) are used to report services for a patient admitted and discharged from observation or inpatient stay on the same day. But a condition is associated with this code that charges these codes; the patient must stay for at least eight hours.
It is critical for the physician to carefully document the diagnosis to assign the correct ICD-10 diagnostic codes. It is essential to specify whether it is chronic or acute and if it is neuropathic, visceral, or somatic.
Hospitalists should explicitly disclose the precise ailment they are treating. They should also report on their examination of lab results or radiological findings. The supplier must expressly state the problem being addressed because numerous physicians may be engaged in the patient’s treatment in a hospital environment.
Working with a trustworthy HIPAA-compliant medical coding firm may ensure adequate documentation and the assignment of correct CPT and ICD-10 codes. American Academy of Professional Coders (AAPC) accredited professional service providers use coders to analyze and validate health care documentation and assign appropriate diagnostic codes, procedure codes, and modifiers. They would do internal audits to see if hospitalists’ documentation complied with the selected evaluation management guidelines. Outsourcing medical coding to a reputable service provider will assist in avoiding denials and guarantee proper claim submission for optimum payment.
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