Emergency Room Billing CPT Codes 99281 – 99285

What is a CPT 99281 code?

It is a commonly used definition of an Emergency Department visit and is used in medical billing.

A 99281 CPT code is a visit that has three main components:

  • A problem-centric history.
  • A problem-centric exam.
  • Very simple medical decision making.
  • Usually, the symptoms the patient presents with are low urgency, requiring little to no immediate medical care. Some of the symptoms that fit under the 99281 code are self-treatable.

This low severity Emergency Room visit requires the least comprehensive chart notes.

 

What is CPT 99282 code?

It is a commonly used definition of an Emergency Department visit and is used in medical billing.

A 99282 CPT code is a visit that has three main components:

  • A longer problem-centric history.
  • A longer problem-centric exam.
  • Simple medical decision making.
  • Usually, the symptoms the patient presents with are low to moderate urgency, requiring low to moderate medical care. The severity is usually moderate to low. Some of the symptoms that fit under the 99282 code may not be self-treatable.

This low to moderate severity Emergency Room visit requires slightly more comprehensive chart notes.

 

What is CPT code 99283?

It is a commonly used definition of an Emergency Department visit and is used in medical billing.

A 99283 CPT code is a visit that has three main components:

  • A longer problem-centric history.
  • A longer problem-centric exam.
  • Moderately complex medical decision making.
  • Usually, the symptoms the patient presents with are moderately severe and urgent, requiring immediate care.

This moderate severity Emergency Room visit requires more comprehensive chart notes.

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What is CPT code 99284?

It is a commonly used definition of an Emergency Department visit and is used in medical billing.

A 99284 CPT code is a visit that has three main components:

  • A detailed problem-centric history.
  • A detailed problem-centric exam.
  • Moderately complex medical decision making.
  • Usually, the symptoms the patient presents with are of high severity, requiring immediate care but “does not pose an immediate significant threat to life or physiologic function”.

 

What is CPT code 99285?

It is a commonly used definition of an Emergency Department visit and is used in medical billing.

A 99285 CPT code is a visit that has three main components:

  • A high detail problem-centric history.
  • A high detail problem-centric exam.
  • Highly complex medical decision making.
  • Usually, the symptoms the patient presents with are of the highest severity, posing an immediate significant threat to life or physiologic function.

SOURCE: CPT 2011, CPT Assistant

57 thoughts on “Emergency Room Billing CPT Codes 99281 – 99285

  1. CODE 99285, I CANNOT FIND THIS CODE IN THE AMERICAN SOCIETY OF ANESTHESIOLOGIST RELATIVE VALUE GUIDE. CAN IT BE USED BY AN ANESTHESIOLOGIST FOR AN ER COMPLEX EVALUATION?
    THANK YOU

    1. Hi Sonia,

      Here is some information that you may find useful from (http://bulletin.facs.org/2013/02/coding-for-hospital-admission/):
      Emergency department (ED) consultation: Patient is admitted
      In this example, a patient presents to the ED, general surgery is consulted, and the surgeon determines that the patient requires admission to the hospital through the general surgery service. For Medicare patients, if the patient is admitted to the hospital by the general surgeon, he or she should bill an initial hospital care code (99221–99223) and not an ED visit code. Medicare requires that the admitting physician append modifier AI to the initial hospital visit code (9922X-AI). If the patient is admitted for observation, codes 99218–99220 are reported. For patients receiving hospital outpatient observation services who are then admitted to the hospital as inpatients and who are discharged on the same date, the physician should report CPT codes 99234–99236.

      For patients with insurance that follows non-Medicare CPT rules, the instructions are even more obscure. If a patient is admitted after an ED consultation and is not seen on the unit (in the intensive care unit, for example) on the date of admission, only report the outpatient consultation codes (99241–99245). If the surgeon sees the patient on the hospital unit on the date of admission, report all E/M services related to the admission with the initial inpatient admission service code (99221–99223) or initial observation care code (99221–99223). Do not report both an outpatient consultation and inpatient admission (or observation care) for services on the same day related to the same inpatient stay. (See Table 2 for the 2013 total initial observation, hospital, same day observation and discharge, and outpatient consultation facility and nonfacility RVUs.)”

      Let us know if that answers your question about consultation/complex eval. Other codes may be used, not 99285 in reference to evaluations, ie anesthesiologist evals.

  2. I recently received a bill from the hospital with a 99285 CPT code. I had abdominal pain and a bladder infection. Why was billed for the highest cpt code? Since when is a bladder infection considered an immediate threat to life? I don’t feel this is an accurate code. I feel I’m being forced to pay way to much. I’m going to call, but I don’t know what to do. It doesn’t seem to me that I was even treated as though I was facing imminent threat to life. My scans came back clear and I was sent home that evening (5 hr visit with about w hours waiting to be seen) I had no surgeries. I had a CT and ultrasound. I also already paid a bill for this. Do you think a 99285 code applies? All of my records were accessible in that hospital as well. This seems like a very dramatic step for the ED to take when they sent me home with what they labeled abdominal pain. 2 days later I was told I had a bladder infection. I was already on antibiotics, just the wrong type. My questiom, where’s the life threatening illness? I’ve had pneumonia and not been given a 99285.
    Thanks

    1. Hi Betsy,

      99281-99285 CPT codes are assigned based on the level of examination and decision-making. The highest severity code 99285 is reserved only for visits that have the highest detail problem-centric exam and highly complex medical decision making. However, as it appears in your case, this code may have been used improperly. A CPT code 99282 may have been more appropriate if you came in with initially presenting “ab pain” symptoms. It doesn’t take complex decision making or consultations like a 99285 typically might.

      If you are on Medicaid or Medicare, it is my understanding that your insurance company must cover this (as in our state of Oregon). If you are not insured, you should take a look into the state covering these emergency room costs for you completely , as there may be a program for the financially needy in your state. Please let me know how else I can help.

  3. My daughter went into the emergency room due to loss of feeling in her legs and pain radiating up one side. They coded it as a 99283 which was denied by the insurance as not an emergency but a minor illness. She ended up receiving a morphine shot and another shot for pain. How is that a minor illness!

  4. My son went to the emergency room with nausea and stomach ache, spent about 2 hours, he was checked for vital signs, checked for an influenza virus via swab test and given one pill for nausea. There were no other tests done. We were charged using 99284 code for his treatment which does not sound right based on the services performed. He was mostly attended by a nurse and had a doctor stopped by for a few minutes to listen to his chest. That was it.

    1. Thank you Dina,
      This is incorrect billing. This is almost the highest severity code they could have used. It should have been 99281 if these were the only tests they ran and he was not put under observation for a critically-perceived event. I would venture to say the chart notes would reveal they did not provide detailed documentation, longer consultation, etc to warrant such a high cpt code.

  5. Hello,
    I was recently in the energency room in regards to an accident that i was involved in. When i went in they took me to a room right away the doctor did take a while to come in which was understandable. He did explain that since i was pregnant their wasnt much they could do if something were to happen to my baby because it was so tiny. He did touch my stomach to make sure it felt okay. He did state that if i would like we could do an ultrasound but it would take hours and hours. I then decided it was better to go to my obgyn. I received an eob today and the doctor billed a 99284 eventhough he didn’t even do anything he wouldnt even use the doppler that a nurse had brought in.

    1. Thank you for the comment Myra.
      We hope everything went okay at the OBGYN. The billing department may have charged a 99284 cpt code because of the percieved danger presented to both yourself and your baby. This is normal, actually. You see, as a prudent lay reviewer, we would approve payment on such an ER claim because under the prudent lay standard – we take into account whether a mother and her unborn child were possibly in danger of being fatally injured/bodily members in danger. In this case, yes there was a possibility of that so the coding was correct — a 99284 or 99285. This is regardless of the actual outcome/tests run by the doc — it’s based on PRESENTING symptoms (perceived by patient). If you felt your child and you were in fatal danger at the onset of the visit, then they coded just fine.

  6. My daughter was passenger on ATV (yes I disapprove of her being a rider at such a young age but was not there to stop it) they hit a bush which made driver hit head on handlebars I guess. My daughter I guess hit her to only leave a reddish dollar size area above eye(no swelling or deformity) both girls crying so parents of driver take them to ER. I came maybe 15-20 mins later and met at ER. Upon arrival dad of other girl is sitting with my daughter and laughing at her doing toe touches off of cot. I asked if ok and she said I guess. I’m not a Dr..but am a EMT-Basic. I feel around and give her a quick rapid trauma exam and pain levels were 0. Might throw this in she’s 6yo. Also my best friend a Dr. and he gets there 5-10 after me. He looks at her literally not exam wise and asks her house she is and she giggles at him saying We ran into a bush. this leads up to question. Hospital bills us a 99281 and tells us if we pay at one time they will knock off 40%. I paid like +-$55. I received a bill of $1200.00 for physician and his code was a 99285. Ive read and my daughter does not meet those requirements. I call hospital and they call physician biller and agree to drop it from 99285-99283. So I’m just wondering “Before I called you out my daughter was a high priority on the verge of death traumatic case but now she isn’t?” I feel like this is fraud on so many levels. I do have private insurance.

    1. Thank you for taking the time Andy, you did the right thing contacting the hospital.

      In your daughter’s visit, it may have happened because she was a child. Children will normally get billed a higher level, though from a financial perspective, you can see it is an unreasonable charge for the duration of the visit and the outcome of the visit (no hospitalization, minimum tests ran, minimum time with doc). These types of codes may be assigned at arrival to ER, and may not be corrected when it comes to issuing the bill. Please reach out to your insurer if you haven’t already.

  7. Went to ER for right side abdominal pain was dehydrated and vomiting. Told them history of Kidney stone several years prior and wanted to make sure it was not appendicitis but possibly a stone. Got morphine for pain and a CT ab/pelvis w/contrast came back as stone. CPT code on bill Is 99284. Would that be correct coding. Thanks.

    1. Certainly, the presenting symptoms may have been judged to be more severe than determined later on. Kidney stone history would definitely help increase the CPT code used. Thank you for the comment!

  8. Our bill says:
    99284 EMERGENCY DEPT VISIT L4
    99284 LEVEL IV ED MEDICAL E&M
    My son was seen because I thought he might have appendicitis. The Dr said usually people cant sit up comfortably if that is the case and seem to be in more distress. He oordered blood work, urinalysis, x ray, ct scan and he didn’t have appendicitis. Do you think this warrants level 4 and should there be a seperate bill for the physician. We don’t have insurance and the bill is $3,770.

    1. Stacey, I understand your situation.. please visit https://www.usa.gov/help-with-bills
      There is information that may help you with the $3,770 bill. I don’t think you should have to pay this as the state may be able to cover all or part of this for low income families. Thank you for your comment!

      1. Was the CPT code of 99284 EMERGENCY DEPT VISIT L4 the correct level for this situation? We have a similar scenario of taking our daughter to the ER for abdominal pain. We wondered if it was an Appendicitis, however, she had no other symptoms. It ended up being constipation. We received the bill and it was coded as 99285. I don’t quite see how her visit was thought to be complex.

        1. “Delaying surgery until the cause of the abdominal pain is certain can be fatal: An infected appendix can rupture less than 36 hours after symptoms begin.”

          For this reason, yes some clinics may treat this as a serious enough event to warrant a 99284 or even a 99285 CPT code. Thank you for your comment Victoria!

  9. I was charged twice for a single emergency visit. The codes were 99283 (with doctor’s name at $475) and 99284 (without doctor’s name at $891). Is this correct?

    1. Thank you for the comment Maria. Please get in touch with Charity Care in your state to get this covered, if your insurance company is refusing to cover the er visit.

  10. Thanks for the clear and concise explanation of CPT codes.

    I visited the ER and medical records document that I presented with High Fever (w/ chest discomfort), cough and headache. After examination, chest xrays and labs were done (blood work and oral swap for flu and strep).
    IV was administered for dehydration and final diagnosis was strep. Was given choice of antibiotic injection or oral prescription. The billing code was 99285, LVL 5. I’m at a loss to how the above examination and treatment fall under life threatening condition. A majority of the time I was resting while getting an IV.

    The hospital billing department is of no help as the ER doctor is a independent contractor and they say he is responsible for the billing code although their room charges are based on his coding. His separate billing was very large based on the coding. 5 months after protesting the billing and follow up, I finally got a response and the doctor’s billing service stands by the coding.

    Based on the above, do you believe I am being over billed and any recommendations on ow to proceed? My insurance company was no help as they said they processed as appropriate and the amount just applied to my deductible.

    Thanks

  11. Thanks for the clear and concise explanation of CPT codes.

    I visited the ER and medical records document that I presented with High Fever (w/ chest discomfort), cough and headache. After examination, chest xrays and labs were done (blood work and oral swap for flu and strep).
    IV was administered for dehydration and final diagnosis was strep. Was given choice of antibiotic injection or oral prescription. The billing code was 99285, LVL 5. I’m at a loss to how the above examination and treatment fall under life threatening condition. A majority of the time I was resting while getting an IV.

    The hospital billing department is of no help as the ER doctor is a independent contractor and they say he is responsible for the billing code although their room charges are based on his coding. His separate billing was over $1,700 based on the coding. 5 months after protesting the billing and follow up, I finally got a response and the doctor’s billing service stands by the coding.

    Based on the above, do you believe I am being over billed and any recommendations on how to proceed? My insurance company was no help as they said they processed as appropriate and the amount just applied to my deductible.

    Thanks

  12. Thanks for the clear and concise explanation of CPT codes.

    I visited the ER and medical records document that I presented with High Fever (w/ chest discomfort), cough and headache. After examination, chest xrays and labs were done (blood work and oral swap for flu and strep).
    IV was administered for dehydration and final diagnosis was strep. Was given choice of antibiotic injection or oral prescription. The billing code was 99285, LVL 5. I’m at a loss to how the above examination and treatment fall under life threatening condition. A majority of the time I was resting while getting an IV.

    The hospital billing department is of no help as the ER doctor is a independent contractor and they say he is responsible for the billing code although their room charges are based on his coding. His separate billing was very large based on the coding. 5 months after protesting the billing and follow up, I finally got a response and the doctor’s billing service stands by the coding.

    Based on the above, do you believe I am being over billed and any recommendations on ow to proceed? My insurance company was no help as they said they processed as appropriate and the amount just applied to my deductible.

    Thanks

    1. Thank you for the comment Michael, we’ve featured it on our Facebook page. Yes, you are being overbilled. Technically they may be right, but in actuality the visit does not warrant all these costs. This type of comment highlights the need for reform because of wasteful and corrupt financial practices in medicine.

      How much is the amount and what is your insurance company? Look over your insurance again, especially on their website where they lay out the terms and their obligations to you (such as urgent care visit coverage, er visit coverage). We’re not familiar with all plans so it depends on what’s there. If they are supposed to cover the visits and only charge you $90, tell them to uphold their end. If they are slapping the entire sum of the visit (thousands of dollars), you should seek out state aid. It is called Charity Care in most states and fill out any form they require in order to cover your bill. Hope this helps.
      Please let us know if you are able to find a way to cover this bill. It will help others.

  13. Hello,

    I recently had a visit to the ER;
    I woke up early AM and really had to urinate. Saw blood in urine (completely red!) and urination was painful. Went to ER, where I had a CT w/o contrast and a blood panel performed, and a urine test were performed. Nothing was found that was particularly alarming and the doctor sent me home with a ‘hematuria’ diagnosis (gee, thanks! I think I could tell I had blood in my urine). By the time I left I was already feeling better w/o any intervention (although I might have received a saline IV – can’t remember at the moment). Everything was quite fast, though I came in at ~6am and the ER was empty.

    I was billed as 99285 for ~$1k by the DR and over $3k (for a couple of hours in the ER) by the hospital. Both charges seem to be unreasonable. Would you agree or disagree? If indeed unreasonable, what are my options other then attempting to negotiate with the dr/hospital? If I do pay the fees (to avoid credit hit), would I be able to sue back for improper codes?

    Thanks!

    1. Hi Kevin,
      Based on your initial presenting symptoms and current prudent lay laws, your visit was coded properly. However, you having to take care of a hefty 4k bill is not reasonable nor warranted. I would suggest looking into Charity Care in your state, or some program like it that would cover this medical expense. Please follow up and let us know what you decided to do/figured out. If you have insurance, please persist calling into your insurance company to see what they can get paid for out of it. Best wishes and hoping for a good outcome for you.

  14. Hi,
    I returned from a camping trip with facial swelling on the left side of my face and forehead. A doctor at a walk in clinic recommended I visit the ER. The only symptom I had was swelling, no pain, trouble breathing, balance or cognitive issues. The ER ran a metabolic panel and hooked me up to a steroid IV for about 20 minutes (during which I was not under observation). They the ran a facial CT scan with contrast, I briefly saw an attending physician who prescribed me antibiotics and a steroid. The bill came out to 13,261.00 with a 99285 billing code, is that correct? Also is 4,899.00 a reasonable cost for a facial CT with contrast? Thanks in advance for any advice!

    1. Hi Drew,
      Please look for a Charity Care program that can assist you in covering these exorbitant charges – and any other programs available to you in your state.

      A 99285 CPT code is for the highest level of emergency- it is reserved for high detail examinations and things like gun shot wounds, severe bleeding, loss of consciousness(concussion) and the like. Based on your presenting symptoms, a doctor / intake nurse may have perceived your condition as very life threatening. This would lead them to run a panel, give you steroid IV and the CT scan… but the same procedures and examination in hospitals all across the US will cite extremely different costs for the same type of visit. This means, you have room to get that bill lowered. Check with your insurance company first, ask to have it completely covered and explain you aren’t able to pay this.
      Persist in asking questions and keep making phone calls. I don’t believe you should be left with this bill, nor do I believe the hospital actually used 13k of its resources on a 20 min patient visit. Feel free to copy this comment and use it in discussions to get your bill lowered or altogether forgiven, if possible. We hope the outcome for you is good.
      PS: Please return and tell us your progress here. It will help others! (Believe us, there are many like you)

  15. Hello,
    I was experiencing flu like systems, swollen lymph nodes and pain in my ear.I went to the emergency room at the advice of an online web doctor that is provided by my employer. I arrived at the emergency room,intake took my vitals and I sat in the waiting room for about 1 hour. I was taken back to a curtained room with a recliner char in it where I was met by a Nurse Practitioner who physically felt my neck/lymph nodes and looked in my ears. The doctor then came in sat down and said “You have allergies”. Take claritin and walked out. The nurse then came in and get me a pill for dizziness. I was at the hospital for an hour and a half, which one hour of that was spent in the waiting room. I was released with papers stating I had an “Earache” . My intake paperwork lists my reason for visit as Earache, Fatigue, and neck pain.

    I was billed by the emergency room hospital 992284 and by the physician at 99283. $2,000.00 for the hospital and $400.00 to the physician.

    Do you think these are appropriate billing codes for this type of visit?

    Thank you,

    Jen

    1. Hi Jennifer,

      Our apologies for the late reply.

      Yes, these are typical bills for similar visits. We believe this visit could be coded 99281 or 99282 more appropriately and the visit may have cost less than what the hospital is charging.

      See if you can contact the hospital to have this re-evaluated, or try the other suggestions in our article: http://prudentlay.org/12-ways-to-deal-with-medical-debt-2016/

      Thank you!

      Prudent Lay

  16. So happy I found this page. My story is I woke up with severe pain in my lower left groin area. When I went to the ER they took my family and medical history, heard my complaints, and sent me for a CT scan. The ER physician read the radiology report and concluded that I had a kidney stone. They loaded my IV with Flomax, Toradol and Dilaudid, and eventually sent me home with a prescription for Oxycodone. All told, I was at the ER for about six hours.

    When the bills came in I noticed that, although the hospital coded the ER visit as a Level 4 (CPT 99284), the ER physician’s billing office coded the ER visit as a Level 5 (CPT 99285). Since the definition of a Level 5 is “life-threatening,” I concluded that the ER physician’s billing office must have miscoded the services. I called my health insurer to ask if they had caught this, and they told me that it is up to the medical care provider to code the services correctly, and basically if the hospital coded it one way and the physician the other way, it wasn’t the health insurer’s concern, and if I had a problem with this I should bring it up with the physician’s office.

    I called the ER physician’s billing office and asked them to re-look this, as it didn’t make sense to me that two medical providers working on the same set of facts would code the services at a different level of urgency/complexity. The ER physician’s billing office said they would investigate, and I received a written reply. The letter summarized the facts and made the following statement: “Based on your presentation and an examination being conducted Level 5 (99285) is accurate according to the high risk and complexity of the medical decision making and the coding and billing guidelines.”

    In my opinion, the explanation from the ER physician’s billing office doesn’t pass the common sense test. It’s not like I showed up at the ER with my guts hanging out, or suffering with a stroke, or with brain swelling inside my skull. Your thoughts?

    1. Hi Greg,

      The billing department may still be able to work with you in reducing the charges for your visit. However, their letter to you does appear to solidify their case for billing CPT 99285 – the “presenting” symptoms appeared severe. If however, you feel they did not do a comprehensive set of tests (only the CT scan), you could ask for a 99284 which may be more representative of the visit.

      Hope this helps.

      Kind regards,

      Prudent Lay

  17. My Husband went to the ER for severe vomiting and was diagnosis with Dehydration. CPT code 99285 was given as the EM code. He was given two bags of IV fluids and pain medication along to nausea medication via IV. I don’t understand why such a high severity EM code was given . I don’t think it was that severe. It sounds like we’re being over charged, does that sound right?

    1. Hi Rumana,

      Yes, in cases of severe vomiting a 99285 or 99284 is warranted. The presenting symptoms appear life threatening to triage staff, physician, etc.

      Thank you for your comment!

  18. My daughter fell off the monkey bars, landing on her stomach, and complained of abdominal pain. We went to the ER where they did an abdominal US and bloodwork and determined she was fine, with no treatment needed. Our total bill so far is over $16,000. We were charged 99284. In addition we were charged a $7500 “trauma activation fee” (CPT 681). From what I can tell, in the Medicare Claims Processing Manual, Publication 100-04, Chapter 25, § 60.4, you can only bill a trauma activation fee (CPT 681) if the patient is triaged in the field or brought in by ambulance. We walked into the hospital ourselves. They are also claiming they did a pelvic ultrasound 76857 and an echocardiogram 93308, neither of which were done. In addition, we are being billed 99204 for a new outpatient visit. We were only seen in the ER. Am I missing something? Are any of these charges valid?

    1. Hi Concerned Mom,

      Your assessment of the billing seems to be sound. Please take a look at our article here for suggestions on actions you can take: http://prudentlay.org/12-ways-to-deal-with-medical-debt-2016/
      First step would be to work with the hospital and the insurer to reduce the bill. If it is necessary (staff uncooperative in reducing bill), talking to a lawyer who offers free consultation about the facts of your situation may help as well (especially if some of these charges are outright false). Maybe having them represent you in a call or two to the hospital will get the wheels rolling.

      Sorry for the trouble you’re facing, and we wish you the best.

      Kind regards,

      Prudent Lay

  19. I was sent to the hospital by ambulance after a car accident, the hospital was crowded so i was forced to get off the stretcher and sit in the waiting room for over an hour and a half. My pain started to get worse and all they did was take my temperature, type some info in the system about my symptoms. I was taken to take xrays of my wrist and forearm evem though that was only one of my issues. Along with abdominal pain, neck pain, back pain and a tight chest. I still had to wait and decided to leave amd go to another hospital after my pain b3came worse and they still did nothing because they had no rooms available and it was completely packed. I was billed the codes of 99285, 93010 and 99053. I feel these codes are incorrect or atleast thw 99285 because they did not treat me as if my injuries were life threatening and they didnt give me nothing for the pain or take any blood only a urine sample to make sure i wasnt pregnant for the xrays of my wrist. What do you think?

  20. I just received my ER bill and just about passed out. I went in for pain in my shoulder. I woke up with it no injury, I was in and out of the er room in 45 minutes this includes registering. When the Dr. Came in he asked me what was going on and I told him I went to the movies the night before and was sitting funny woke up in this pain. He said I had a pinched nerve and said that if it didn’t get better by Thursday call my Primary care physician. Then he told the nurse to call down and get me 2 predison tablets to take before I left and they gave me a prescription for it too. They charged me ED Visit Level 3 99283 $1,180.36 and EDPHY-ED Evaluation LVL 3 99283 $222.88 That is unreal can that be right he was in the room with me for a total of 4 minutes. My daughter was with me and she even said wow he was in and out. What is the charge of $1,180.36

    1. Hi Linda,

      For non emergency visits, where you are in not in a life threatening condition, it is recommended you see Urgent Care. As far as your ER charges, a 99281-99282 may be more appropriate to bill in this case. Please reach out to the hospital billing department and explain the brevity of your visit, the low-level examination (no tests run, etc) that warrants a lower CPT code.

      Unfortunately, it is typical for hospitals and physicians to charge higher CPT codes than necessary for non life threatening visits like these.

      Kind regards,

      Prudent Lay

  21. Hi, thanks for the info. It is very much appreciated.

    I had reaction to a seasonal allergy while working out of town in Northern California (Sacramento Area) for a contractor. I started having a hard time breathing. Before this I had never had a reaction of the kind. Since I was at work, I went to a clinic that focuses on industrial labor. At the clinic they took x-rays, and I was told that there were nothing in my xrays, but that they did not want me to get worse. So, the clinic called an ambulance to take me to the hospital, and I received a nebulizer treatment on the ambulance that got me breathing much better. Once I was at the hospital, the people at the ER and the man from the ambulance asked me how I was doping. I told them I was feeling better, and that the treatment on the ambulance had helped. We talked for a bit more, and they told me that it was just me having a reaction to seasonal allergies. The man from the Ambulance told me that it was common that as you age, your allergies become stronger. They gave me another nebulizer treatment, and I was there for about tow hours. I paid with card, since I am uninsured, when I was discharged for what they told me was the bill.

    I eventually received a bill for the ambulance, and I paid for that.

    Abouy 5-6 months later, when I was no longer working for that contractor, I received a call from a collections agency. They told me that I had an unpaid amount. The amount was very close to the ambulance bill, so I thought that they were talking about that. I told them I had paid the amount, and that there was some kind of mistake. The collections company told me that I should send them the receipt for the payment I made but they gave me very few details about who I was sending it to, and why. When I was abought to send it, I realized it might be a scam because they were so ambiguous with instructions, and gave me a simple gmail account to send my receipt to, instead of an account with a domain name. So, I instead sent an email requesting more information, and waited for a response. They eventually called me again, and told me they would send me more information. Finally, about 4 months later, and almost 10 since the original event, I received an letter with the “original” bill. I had never received this bill, and I had received other communications from the hospital (like a request to fill out a survey).

    Anyways, on the bill there is a 99285 CPT code. And they’re charging me a little over $3k (The original is well over $4k before some kind of uninsured discount). I’m not really sure what to do with this, as it seems underhanded, and now I have a collections agency after me.

    1. Hi Juan,

      Do you know the hospital where the ER visit took place? Call them them regarding this collections bill you received with the 99285 CPT code and verify that it is actually from them, and not a scam of some sort. If they say your bills are all paid, then you may be able to report this collections bill to an appropriate agency – https://www.usa.gov/stop-scams-frauds.

      Hope this helps!

      Kind regards,

      Prudent Lay

  22. My husband went in ambulance to ER due to a bad muscle strain in his back. The EMT put in IV and gave him meds to help with pain. There was no way I could get him there by myself. Once at ER, doctor did a brief exam and ordered a CT scan but basically came back and confirmed the muscle strain. This visit was coded as 99284 by both hospital and doctor. Doctor had addtional code of S39.012A which confirms diagnosis of strain. His vitals were fine and no other tests were done. After looking at your definitions, how in the world was this coded a 99284. The insurance has paid their portion but I am appealing due to the coding as we still had much of our deductible to pay first. Am I right to question this? Also, the CT scan was coded 72131, priced at almost $3000. Does this seem like reasonable cost? We had no control of pricing since at the ER. So frustrated as I can still not get the hospital to send me a detailed bill. I requested for third time today. I am going off the insurance EOB.

    1. Hi Gina,

      I have to agree with you on the $3000 CT scan. This is an overpriced procedure and you may be able to reduce this charge.

      As far as the 99284, if there was a comprehensive examination and multiple tests, then it would have been valid – also if he had a life threatening injury, risk of loss of limb. If you can make a case to the hospital billing department that there was nothing to warrant a CPT 99284 code, they may be able to reevaluate their coding down to 99283, possibly a 99282.

      Kind regards,

      Prudent Lay

  23. Hello,
    Our son crashed on his dirt bike and injured his knee. My husband took him to the ER. They were there for just under an hour. They gave him one shot for pain, took one xray and saw that it was a small fracture and that we needed to follow up with an orthopedist. They gave my son a flimsy brace, crutches and then sent us on our way. They coded it a 99284 (ER Room) and charged $3919.50. This does not include the Pharmacy Service $77.25 (morphine injection), IV Therapy $356.50 (which was the administration of the morphine injection) and X-Ray $659.50. This all seems way too much $$$. Is this normal?

    1. Hi Devera,

      The ER visit was for a vehicular accident (dirt bike), so it does warrant a 99284 or 99285. As far as ER visits go, this bill is high. The $3000 dollars is probably the cost of the triage team used at the hospital to provide emergency care. This is, unfortunately, “normal” medical billing for the United States.
      Reaching out to the billing department at the hospital and the insurer may help reduce the bill. Please see our article on suggestions for these situations:
      http://prudentlay.org/12-ways-to-deal-with-medical-debt-2016/

      Kind regards,

      Prudent Lay

  24. Hi,
    I took my daughter to a children’s hospital emergency department. She fell off a ladder, appx. 4′ fall, and landed on her left side (elbow and then head). It was determined with no xray or MRI, absolutely no imaging, that she was fine to go home. We had asked for an MRI to rule out anything serious unseen but said it was not necessary. If I would have known they would not do an MRI, I would have stayed at one of the two urgent cares we went to in the first place. We left when they said they didn’t have MRI capability nor CT scan, only xray. My daughter could have obtained the same result from the urgent care, which we wanted in the first place, but she was too dizzy to just assume there was no need of one. The bill has an SVC code of 7230092 with a Level 3 ED visit, CPT 99283. ER Bill for $1,061.00 and attending physician bill of $193. The ED visit of $1,061 is what seems awfully steep to me for just waiting around in the room for almost 2 hours for the doctor to do a 5 minute evaluation. The vitals were taken once when first going back to the room; that’s it. No blood work, no medicine, and no imaging were offered or ordered. Shouldn’t this be negotiated for much less as less is warranted? And, what is the best strategy for negotiating this as self payer. We have no insurance- can’t afford the premiums, yet do not qualify for assistance.

    Thank you for any help/advice at all.

    1. Thank you for your comment!
      I would advise taking a look at the article we published earlier in 2016–http://prudentlay.org/12-ways-to-deal-with-medical-debt-2016/
      It lists some of the strategies you could use to reduce these medical bills.
      We wish you the best,
      Prudent Lay

  25. DOUBLE CHARGED? I went to the ER at 12:30 AM – 5:30 AM for excessive, unquenchable thirst and dry mouth. I had recently gotten over a cold virus followed by acute bronchitis for 3 weeks. Several days prior to this ER visit, I had visited Urgent Care for these same two conditions and got an IV hydration (which must have done some good as the chapped lips I’d had for years were instantly healed) plus I was advised to drink more gatorade-type electrolyte beverages. Instead of the thirst getting better in the days following, it got worse. I had stopped using cold medicines weeks earlier, but I wondered if that cold medicine (guiafenisin) according to package directions that I had used off and on for 2 weeks had adversely affected kidney function (no). The facilities bill charged me for CPT 99283 ER Visit Level 3 at $841.80 and the separate physicians bill charged me for CPT 99284 Emergency Room Visit at $1,425.00. Am I being double charged here – once by the Facility for CPT 99283 and again by the Physician for CPT 99284?

    1. Hi Kay,

      It is normal for the facility and physician to charge their own codes. Based on your initial presenting symptoms in the ER, I would agree with the codes used. If you want a reduction to your bill, see about contacting the billing dept of the hospital to get it reduced. Let them know about your financial situation as well if you’re struggling with bills, etc. It may help. Also your insurer for further suggestions.
      Best wishes.
      Prudent Lay

  26. Our 2 yo was cranky and she had trouble moving her neck. We took her to a free standing ED where the tested her for the flu and gave her Motrin (it happened in Jan). They did 2 x-rays, one on her neck and the on her spine (seemed excessive but it may have been a slow day for them, we were the only ones there). Once the Motrin kicked in she was perfectly fine, jumping and playing. We received a bill for over $3,000 with the CPT code 99284. I’m appalled at their choice of severity level. Maybe it’s my ignorance but it seems as if they are reaching here. Thanks for any input!!!!

    1. Hi Adrienne,

      When babies come into the ER with an issue, it is often treated a bit more urgently. Based on the tests done (xray and for flu), this may be appropriate billing the code 99284. However, the charge is high on the patient – that we agree with you on. The code used is based on the initial presenting symptoms, not on diagnosis. If you want a reduction, see about contacting the billing dept of the hospital to get it reduced. Let them know about your financial situation as well if you’re struggling with bills, etc. It may help.
      Best wishes.
      Prudent Lay

  27. Hello, I went to the ER for kidney stones, but I’m being charged with the code 99285 level 5? How is that life threatening? Am I being over charged? 956 dollars seems Alot?

    1. Hi Samuel,
      Thank you. The triage nurse made this assessment based on initial symptoms when you presented in the ER. If you want a reduction to your bill, see about contacting the billing dept of the hospital to get it reduced. Let them know about your financial situation as well if you’re struggling with bills, etc. It may help. Also your insurer for further suggestions.
      Best wishes.
      Prudent Lay

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