The role of the hospitalist evolved in response to the growing demands of primary care providers, many of whom struggled with balancing demanding office visit schedules against the needs of their admitted, hospital patients. For the primary care provider, having hospitalists in the group means fewer trips to the hospital during off-hours, and relinquishment of the patient admission process, including:
- the patient exam
- reviewing the patient’s history and medications
- writing the admission orders
- performing other tasks that would have historically required that a primary care physician make trips to the hospital or spend many overnight hours coordinating a patient’s hospital admission.
Hospitalist’s are location-centered, similar to emergency medicine or critical care (i.e., intensive care unit-based), as opposed to organ-centered (e.g., cardiology) or age-centered (e.g., pediatrics). Hospitalists generally do not provide out-of-hospital services, meaning patient’s usually return to their primary care physician for follow-up care upon discharge from the hospital.
Hospitalist billing is coming under increasing payer scrutiny due to the high number of comprehensive visits billed for subsequent inpatient visits. In addition, the use of non-physician providers for inpatient visits requires an in-depth understanding of rules that govern split and shared visits. Coding for hospitalists must address the code requirements for each inpatient service level and address proper documentation of medical necessity, critical care, and other timed services.
Generally, the types of codes reported for hospitalist services that must be monitored for appropriate documentation and accurate coding include the following:
- Hospital inpatient services codes
- Initial hospital care
- Subsequent hospital care
- Hospital discharge services
- Inpatient consultations
- Hospital observation services codes
- Observation care discharge services
- Initial observation care
- Observation or inpatient care services (including admission and discharge services)
- Critical care services codes.