Improving healthcare value: Optimizing billing and documentation for inpatient addiction consultation services

Vollständiger Abstract

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Abstract Patients with substance use disorder (SUD) represent a high‐complexity, high‐cost population on hospital medicine services, yet their admissions are systematically under‐reimbursed due to narrow clinical documentation. Increasingly, hospital‐based addiction consultation service (ACS) clinicians provide dedicated addiction care to medically complex hospitalized patients. Hospitalizations coded solely for SUD fail to capture clinical complexity and concomitant diagnoses, depressing diagnosis‐related group weights and Case Mix Index. We describe three actions for ACS clinicians, hospitalists, and system leaders: (1) document the complete clinical picture, (2) utilize advanced billing mechanisms, and (3) build institutional infrastructure to improve reimbursement to support long‐term ACS sustainability.