Home Poll A look at hospitalist coding patterns

A look at hospitalist coding patterns

February 2010

Published in the February 2010 issue of Today’s Hospitalist

IN THE 2009 TODAY’S HOSPITALIST COMPENSATION & CAREER SURVEY, we asked readers to tell us what level of codes they choose when it comes to three areas: initial visits, subsequent visits and consults. One common thread that runs throughout the results is the difference that employer model makes in the coding levels that hospitalists choose. Hospitalists not employed by hospitals and universities, for example, tend to be more aggressive about using higher levels of codes. And as hospitalists’ experience increases, so does their use of higher level codes. Here’s a look at survey trends in hospitalist coding.

What type of code (low, medium, high) do you use for initial visits/H&Ps?

Low: 5.23%
Medium: 33.84%
High: 60.92%

High-level codes for initial visits are most frequently used by hospitalists employed by multispecialty groups (65.69%), compared to hospitalists employed by universities/medical schools (58.48%). Perhaps because more hospitalists in the Pacific and Southwest work for local hospitalist groups or multispecialty practices, it’s not surprising that hospitalists in these areas report using high-level codes more frequently (67.02%) than colleagues in other parts of the country.

The survey also found significant variation among coding levels by specialty. Pediatric hospitalists, for example, are less likely to use high-level codes for initial visits (35%) than adult hospitalists (64.49%).

Finally, more experienced physicians “those with six to 10 years of experience “tend to use higher level codes more frequently than physicians with two or less years of experience (65.46% compared to 55.66%).

What type of code (low, medium, high) do you use for subsequent visits?

Low: 11.91%
Medium: 58.01%
High: 30.07%

The use of high-level subsequent codes is lowest among hospitalists employed by hospitals (26.42%), and highest among hospitalists employed by local hospitalist groups (33.99%).

Presumably because of trends in employment models, hospitalists in the Pacific region reported using high-level codes for subsequent visits 41.24% of the time. In the Northeast, where almost two-thirds of hospitalists work for hospitals, that number drops to 25.90%.

When it comes to subsequent visit codes, high-level codes are used more frequently by adult hospitalists (31.17%) than pediatric hospitalists (20.58%).

What types of codes (low, medium, high) do you typically use for consults?

Low: 10.18%
Medium: 54.42%
High: 35.40%

As of last month, Medicare eliminated consult codes, so it will be interesting to see how that coding change affects 2010 survey results. In 2009, as with initial and subsequent visit codes, our survey data pointed to differences by specialty in the use of high-level consult codes. Adult hospitalists, for example, reported using high-level codes 36.81% of the time, compared to pediatric hospitalists, who reported using high-level codes 25.87% of the time.

The survey data uncovered another trend related to group size. Hospitalists at larger groups reported using high-level consult codes more frequently than their colleagues at smaller groups.

Hospitalists working for groups with more than 15 physicians, for example, reported using high-level codes 41.28% of the time. By comparison, groups with only one to four physicians reported using high-level codes 30.78% of the time. (This trend also applies to the use of initial and subsequent visits.)

More survey results

Results from our 2016 Today’s Hospitalist Compensation & Career Survey can be found online at www.todayshospitalist.com.