Billing errors
Was your ER visit coded too high?
Emergency visit levels are the most commonly challenged codes on hospital bills.
Emergency department visits are billed in levels, from a low simple visit to a high complex one. The level drives the price, so it is a natural target for a billing office and a natural question for you.
| Code | Meaning |
|---|---|
| 99281 | ER visit, lowest level |
| 99282 | ER visit, low level |
| 99283 | ER visit, moderate level |
| 99284 | ER visit, level 4 of 5 |
| 99285 | ER visit, highest level |
How to challenge it
The honest way is to ask, not to accuse. Ask for the record that supports the level, ask what the emergency department's own documentation says about the complexity of the visit, and compare it to what the insurer allowed.
A better time to argue
A coding argument is strongest once insurance has processed the claim and you can see what you were actually charged for the level. Before that, you are guessing. In our own case, the argument that worked was on a small remaining balance, not on the big facility charge, because that was the part that had actually posted.
Not legal or medical advice, and not a coding opinion. If the amount is large, a professional coder or a patient advocate may be worth the cost.