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E/M frequency data for hospitalists

Hospitalists became a recognized specialty by CMS starting in April of 2017, and we now have frequency E/M data for 2018. It’s not a full year, and there are probably many physicians who did not switch their specialty designation, but it’s a start.  Physicians self-elect their specialty designation with Medicare and other payers. Many hospitalists are family medicine or internal medicine physicians by training, working as hospitalists.

The data below is from 2019, released in late 2020.

Initial inpatient services, 99221–99223

Initial inpatient Family Medicine IM Hospitalist
99221 6.56% 4.80% 3.84%
99222 34.22% 226.59% 19.59%
99223 59.22% 68.61% 76.57%

For hospitalists, 75% of their initial inpatient services are billed as level 3 visits, compared to 58% for family medicine and 68% for internal medicine. I review the E/M data each year, and this rate of level three initial hospital services is one of the highest of any specialty group.

Pulmonary doctors bill 99223 for 66% of their visits, cardiologists bill 99223 for 54% of their visits. Physicians who are designated as critical care/intensivists bill 62% of their initial inpatient visits as 99223s. Infectious disease physicians bill 51% of their initial inpatient services as 99223s.  Interventional cardiologists bill 54% of their initial inpatient services as 99223s.

Initial hospital services require all three key components, a comprehensive history, comprehensive exam and high complexity MDM.  If I were involved with a hospitalist group, I would certainly track this metric by physician and include high level E/M services in my audit plan for the year.

Subsequent hospital services, 99231—99233

Before we look at subsequent hospital services by specialty, let’s turn back the clock. The earliest frequency data I’ve saved is 2000.

Internal medicine, subsequent hospital visits Family medicine, subsequent hospital visits
2000 2019 2000 2019
99231 26.21% 4.90% 99231 33.32% 11.76%
99232 56.48% 58.47% 99232 53.98% 36.17%
99233 17.13% 36.63% 99233 12.70% 52.07%

Between 2000 and 2018, the frequency of using 99231 dropped for both specialties, and the frequency of using the highest-level subsequent hospital visit increased for both specialties, considerably. The middle code, 99232, the “safe, fly-under-the-radar” code increased for both specialties.

Now, let’s look at current data and compare FM, IM and hospitalists. Hospitalists have the lowest frequency of using 99231, and the highest frequency of using 99233. Subsequent visits require only two of the three key components.

Subsequent Family Medicine IM Hospitalist
99231 7.44% 4.90% 3.56%
99232 61.41% 58.47% 53.32%
99233 31.15% 36.63% 43.13%

Observation, and admission and discharge on the same day, 99218—99220, 99234—99236

OBS admissions Family Medicine IM Hospitalist
99218 7.44% 4.59% 2.83%
99219 36.60% 26.89% 24.17%
99220 55.96% 68.52% 72.99%
Adm/DC same day
2018
Family Medicine IM Hospitalist
99234 11.55% 8.80% 5.19%
99235 45.35% 35.38% 33.92%
99236 43.10% 55.82% 60.89%

These are consistent with inpatient admissions.  Hospitalists report higher levels of initial services for observation admissions, and for admission and discharge on the same calendar date. It does lead to the question, are hospitalists managing sicker patients, or documenting them more completely or billing them at too high a level?

 

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Get you FREE quick reference sheet The Definitive Guide to Documenting Time. This resource reviews what to document and gives specific examples for E/M Services based on time

•  In the office
•  Inpatient status
•  Prolonged Services
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Relevant Search Terms: bell curves, hospitalist coding, frequency for hospital services, IM and FP E/M frequency

Last revised January 6, 2021 - Betsy
Tags: Documentation Guidelines

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Our mission is to provide accurate, comprehensive, up-to-date coding information, allowing medical practices to increase revenue, decrease coding denials and reduce compliance risk. That's what coding knowledge can do.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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