# Using Mid-Levels for Hospitalist Program



## Pam Brooks (Apr 15, 2010)

Hi, I oversee the coding department for a facility that employs a hospitalist group.  They would like to begin using mid-levels to perform Initial Hospital Services (in this case, admissions).

The issue is that they want to also bill for same-day Hospitalist (MD) services prior to the admission; the MD hospitalist has made the decision to admit, but brings the mid-level in to do the H&P.  After I explained that we cannot bill two Hospitalist services for the same day, and went over the other scenarios we can/can't do (shared visits, concurrent care, etc.), the hospitalist director insists that this is being done nationwide.  It may very well be, but I'm not sure who is able to get away with billing both services.

Anyone out there who is billing a hospitalist MD visit and a hospitalist mid-level visit on the same day (related to the admission?)  Thanks!  Pam


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## aguelfi (Apr 16, 2010)

we only bill for the hopsitalist admission.  They ins is only going to pay for 1 from the same group.


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## sparkles1077 (May 2, 2010)

We do have a similar scenario.  Midlevels often see the patient and complete the H and P as preparation.  The physician then comes in and repeats an exam and finalizes MDM.  We bill this service under the physician, even though the midlevel is involved.  The physician should be doing most of the documentation (his exam and mdm).

What service is the MD trying to bill prior to admission?  Office visits?  We have physicians who bill office visits and send patients over for admission, but the office visits are not paid.


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## randiroyder (May 3, 2010)

I do the coding for a large hospitalist dept in Texas and we also use mid-level to admit and for subsuquent visits. The mid-level does the H&P and then the doctor comes in and does the exam and plan, tieing in with the mid-levels H&P. So both notes are used for the E&M code.  The mid-level sometimes does the intire admission and bills under their number. So either way will work.

I hope this helps,


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## Cynthia A (May 3, 2010)

I too code for a group of hospitialist.  Whenever the mid-level does a admit or subsequent visit the Physician must also sign the documented note. There are guidelines as to what must be documented by the Physician. This is a split visit and both get RVU's for it.  If the Physician does not sign off the note he does not get RVU .


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