Coding For Hospitalist Group

renifejn

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I was wondering if anyone does coding for hospitalist groups? I'm going to start soon and was curious to see if anything is different or if there are different rules? Or if there is a site where I can do some research?

Thanks in advance.
 

sbittar35

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code 96116

In a hospital outpatient if you have 99242 and 96116 do you need a modifier?
Can you help me with that?


Thanks,

Silvia
 

ARCPC9491

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96116 "mini mental exam" is included under the psych bullets (1997 guidelines) when a physician performs a mini mental he/she would get the bullets for the items they documented. so sometimes when other things are being examined, the psych bullets can help get a higher level exam.
 

sbittar35

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What you mean by bullets, can you be more specific

Can you be more specific with the meaning bullets. Can I send 99242 and also 96116
 

ARCPC9491

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pull up the psychiatric "bullets" under the "general multi system exam" in the 1997 documentation guidelines.

If your provider has an expanded problem focused exam (needed for 99242) the extra bullets for the psychiatric exam (which is a mini mental or 96116) may allow your physician to get a higher level exam, such as detailed (which is needed for 99243) it might bring up the overall E/M visit, as long as the history and medical decision making meet as well.
 

acward

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I code for a hospitalist group also. My biggest frustration is helping the docs to understand the difference between a consultation and a transfer of care. The Medicare Carrier's Manual is really helpful with this issue.

Annette, CPC
 

kmaher

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I too code for a hospitalist group which also include Midlevels. Does anyone else have Midlevels? This part is new to our practice, and we have had some push back from the Midlevels, as to what they can and can't bill for in the hospital setting under the split/shared visit.
 

Titali80

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I have recently started working for hospitalist group. we have more than 25 Internist going to few different hospitals and I am just trying to figure out how to be beneficial with my knowledge and how to develop coding department, who does medical chart review, auditing and review physician who are lower coder to educate them to improve on MDM and documentation strategy. Anyone outthere have similar objectivity who would like to share more?
 

jimbo1231

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Feedback

I've done work for Hospitalist Groups and several others on here have done coding for them. My experience is Hospitalists probably shouldn't be doing their own CPT coding, but most practices still do. And it sounds like that is the case with you. So what I've done is;

- Develop an E&M spreadsheet by provider (looks like you have done that). Identify outliers both on the low and high end.
-Audit a sampling of each providers coding to the chart documentation
-Based on findings develop an in service for the providers focusing on documentation and coding.Meet individually with the problem providers with actual documentation/coding examples
-Establish a monthly meeting to review overall trends in E&M Levelling etc
-You might also do a more complete integrity audit to see if there are missing charges. This would be tracking a sampling of the hospitalists coding from the chart through billing to see if there is a need to develop an improved accountability process.

The problem areas I have seen have included under and occasionally over coding of Levels. Simply incorrect coding where the provider will use the same Level throughout the hospitalization. Incorrectly coding discharge day services. and a lack of understanding of Observation and Critical Care documentation and coding. And typically significant provider turnover requiring an ongoing credentialing/education process. But besides that there are no problems! As I stated above they probably shouldn't do their own coding..

Jim Strafford

Good Luck
 

Titali80

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Oh I am so sorry, I am still newbies to these so didn't see your generous response earlier. I greatly appreciate your feedback. Yes I am going to follow and integrate few points that you mentioned in my auditing. Goal is to increase revenue, avoid being audited and of course to improve without compromising quality of care.
 
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