Wiki Hospitalists - Medicare retractions for Observation E/M

[LChassereau]

Hi all - I am looking for some guidance. I am receiving Medicare Part B retractions after payment was made for my hospitalists providers Observation E/M services (mostly Discharge 99217) with retraction denial of paid to another provider. Our group is only allowed one code per day per patient. We are the admitting group responsible for the patient care while in the hospital (all other Obs codes are paid). However, when we request a consultation from a specialty, if that provider bills on same day of the DC they are denying or retracting our payments and paying the consult provider. I have appealed due to different specialty, different entity, different tax id, different dx and we are the admitting/treating group responsible for the patient care with no luck - all have been unfavorable. I do not have this issue with Inpatient claims, just Observation.

I feel like some part is the consult codes no longer valid for Medicare, so the consulting provider might be submitting the incorrect codes (same Obs codes as our group), however I can not control that. Can anyone help with suggestions or maybe they experience the same issues? Any help will be appreciated. Thank you

 

[Thelly27]

I am not sure what code the consulted groups are submitting, but the observation codes should be submitted only by your group. If this other group was consulted in, and its outpatient medicare, they should be using (99201-99215) (depending on if they are new or established)office visit codes.