Hospitalist Services

February 12th, 2009 - Codapedia Editor
Categories:   Coding   Evaluation & Management (E/M)  
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Hospitals are adding hospitalist services at a fast pace.  Everyone is recruiting for hospitalists.  It's changed the face of primary care.  Primary care physicians are now in their offices more hours of the day.  Their hospitalized patients are cared for by a group of physicians without office responsibilities.  Hospitals say they experience increased quality, and decreased length of stays.  Initially skeptical patients report that it is a relief to have the physician in the hospital all day, both to address medical problems that come up during the 24 hour period, and to talk to the family.

But how do we bill for these services?

The first thing to remember is that there is no such specialty as "hospitalist." In fact, spell checker doesn't even like the word!  These physicians are enrolled in Medicare and with the commercial insurance companies with the specialty in which they were trained: Internal Medicine, Pediatrics, Family Practice, Pulmonary Medicine.  Keep that in mind when coding for these services, and review the rules for payment to physicians in a group of the same specialty.  There is a Codapedia article on that topic.  There are also Codapedia articles on the specific rules related to inpatient and observation hospital services, critical care, prolonged services and two E/M services in a single day.  See also billing for a post op service by the hospitalist physician. All of these pertain to hospitalist billing.

Change of shift or coverage by physicians of the same specialty in the same group doesn't mean that a second visit is payable.  Often, these physicians are paid based on the relative value units they produce, and the issue becomes one of how to allocate the RVUs for that day.  But, this doesn't change the rules related to E/M services. 

Some hospitals have now hired physicians they are calling "Nocturnists."  This is a physician who is hired specifically to work over night, covering the patients on the hospitalist service.  The rules related to two E/M services in a single day still apply.  There is no specialty designation for a nocturnist.

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