99217 and 99224

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hi i have a situation where insurance paid both 99217 which was billed by a hospitalists (internal med) and on the SAME day, a pulmonary specialist from different group also saw patient and billed 99224. Now the ins is requesting refund for 99217 stating that it is bundled with another service. is there a way I can rebill the 99217?
 
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hi i have a situation where insurance paid both 99217 which was billed by a hospitalists (internal med) and on the SAME day, a pulmonary specialist from different group also saw patient and billed 99224. Now the ins is requesting refund for 99217 stating that it is bundled with another service. is there a way I can rebill the 99217?

I might be able to help you...

It's a pretty straight-forward rule that 99217 and 99224 cannot be billed for the same DOS. 99217 will get bundled.

SO, first (as always), is this a Medicare patient?

Second, I assume the patient was not a same day admit/discharge since you're billing 99217...? How long was the observation stay?

Third, if I understand you correctly, the Internal Med provider (from Group A, let's say) was discharging his/her patient on such and such date. With regards to the pulmonary specialist, is he/she from an OUTSIDE group (Group B), totally unrelated to the facility where the patient was at (Group A)? If so, why was a pulmonary specialist was brought in from an outside facility? Why didn't Group A have a pulmonary specialist from their own group, Group A, see the patient rather than having someone from the outside do it? Also, was the pulmonary specialist there for a consultation? Did the pulmonary provider know the patient was going to be discharged on that particular date? Did the patient get discharged and then went to see the pulmonary provider?
 
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