My two kids have each recently had an ER visit to the same Emergency Room (separate dates, separate incidents.) The billing for both visits includes separate charges for “Significant, separately identifiable evaluation and management service by the same physician….” that seem redundant. Are these legit?
ER visit #1 – My daughter fell and hit her head and had a concussion. The doctor examined her, asked questions about symptoms, shined light in her eyes, etc., diagnosed a concussion, and sent us home with instructions on concussion care and warning signs. No imaging was taken. Nothing but the doctor examining her and talking to us. Charges were:
$480 – Code 99284 – “Emergency Department visit for the evaluation and management of a patient…”
$482 – Code 450 modifier 25 – “Significant, separately identifiable evaluation and management service by the same physician on the day of procedure.”
I’m not sure what extra was done by the physician to justify a “significant, separately identifiable evaluation and management service”. Is this charge legit?
ER visit #2 (same ER, different date) – My son fell off his bike and we thought he had a broken arm (turns out it wasn’t broken). The doctor examined his arm, took x-rays, and told us it wasn’t broken. Charges were:
$150 – Code: 73080 – Radiologic Exam, Elbow
$158 – Code 320 – Radiologic Diagnostic
$307 – Code 99283 – “Emergency Department visit for the evaluation and management of a patient…”
$535.37 – Code 450 modifier 25 “Significant, separately identifiable evaluation and management service by the same physician on the day of procedure.”
I’m wondering whether the additional “separately identifiable evaluation” charges are justified or just something this ER automatically tacks on. My insurance did approve the charges, but we’re paying the majority of it out of pocket due to a high deductible. If the charges aren’t justified, how do I go about contesting them?
Thanks for any help!
submitted by /u/LakeRat
[link] [comments]My two kids have each recently had an ER visit to the same Emergency Room (separate dates, separate incidents.) The billing for both visits includes separate charges for “Significant, separately identifiable evaluation and management service by the same physician….” that seem redundant. Are these legit? ER visit #1 – My daughter fell and hit her head and had a concussion. The doctor examined her, asked questions about symptoms, shined light in her eyes, etc., diagnosed a concussion, and sent us home with instructions on concussion care and warning signs. No imaging was taken. Nothing but the doctor examining her and talking to us. Charges were: $480 – Code 99284 – “Emergency Department visit for the evaluation and management of a patient…” $482 – Code 450 modifier 25 – “Significant, separately identifiable evaluation and management service by the same physician on the day of procedure.” I’m not sure what extra was done by the physician to justify a “significant, separately identifiable evaluation and management service”. Is this charge legit? ER visit #2 (same ER, different date) – My son fell off his bike and we thought he had a broken arm (turns out it wasn’t broken). The doctor examined his arm, took x-rays, and told us it wasn’t broken. Charges were: $150 – Code: 73080 – Radiologic Exam, Elbow $158 – Code 320 – Radiologic Diagnostic $307 – Code 99283 – “Emergency Department visit for the evaluation and management of a patient…” $535.37 – Code 450 modifier 25 “Significant, separately identifiable evaluation and management service by the same physician on the day of procedure.” I’m wondering whether the additional “separately identifiable evaluation” charges are justified or just something this ER automatically tacks on. My insurance did approve the charges, but we’re paying the majority of it out of pocket due to a high deductible. If the charges aren’t justified, how do I go about contesting them? Thanks for any help! submitted by /u/LakeRat [link] [comments]Read Morer/HealthInsurance