Hospitalist Coding Best Practices: Breaking the Code Toward Higher Revenue

bestpracticesLast week, MDeverywhere hosted a webinar on best practice revenue cycle processes for hospitalists.  Included in that was information on best practices hospitalists can use in coding and documentation.  More specifics on that topic are included in a free white paper entitled Breaking the Code Toward Higher Revenue: Coding Best Practices for Hospitalists.  You can download the white paper here. In this comprehensive white paper we cover best practice coding guidelines from the first to last visit, the three key components of evaluation and management coding and special considerations for the various types of visits. Among other topics, the white paper includes information on two of the more confusing aspects of hospitalist revenue cycle - how to code for daily concurrent care as well as the details around time-based coding. With hospitalist revenue cycle management, concurrent care can can become a medical necessity denial if multiple providers render services on the same day.  Hospitalist codes are per codes, that means the codes represent the services provided during the entire day and only bill one visit per day can be billed.  This is true even if the physicians belong to the same group and have billed more than one visit, eventually only one visit can be billed and reimbursed.  It is important to note that billing two separate initial or subsequent visit codes in a single day is inappropriate.  Combining the elements of both the visits into a single higher level of visit is acceptable and more accurate. Many of the evaluation and management categories containing levels of service can alternatively be coded by time if the encounter is characterized by either counseling or coordination of care.  You should be aware of which code sets can be handled this way.  In the case where counseling and/or coordination of care dominates (more than 50 percent) of the physician and/or family encounter (face-to-face time in the office or other outpatient setting, floor/unit time in the hospital or nursing facility) time may be considered the key or controlling factor to quality for a particular level of evaluation and management service.  This includes time spent with parties who have assumed responsibility for the care of the patient or decision making whether or not they are family members.  The extent of counseling and coordination of care must be documented in the medical record. A visible improvement in patient care and increasing patient satisfaction has been obvious outcomes of the growth of hospitalist programs.  While these programs encourage appropriate admissions, reduce costly re-admissions and decrease the length of stay for many patients; there are many confusion aspects to accurate coding of the work Hospitalists do.  Things are getting murkier in the revenue cycle for the hospitalist practice.  This best practice white paper explains coding best practices for to ensure that every hospital visit and service provided is thoroughly and properly documented and appropriately reimbursed.