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

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.