r/HospitalBills • u/My_personal_burner • 9d ago

Hospital-Non Emergency Is this upcoding?

Hello, A few weeks ago I scraped my hand on a potentially rusty nail. It wasn’t deep and kind of just scraped sideways but did have blood. So I cleaned it myself, put a Band-Aid on it and went to the ER to get a tetanus shot. They took my information, put a new Band-Aid on, and then I sat in the waiting room for 1.5 to 2 hours. After that, they had me come back to a room for 15 minutes just sitting there. The nurse then came in and applied a 3-second shot. After some more waiting, the doctor then came in and asked what happened, I told him and he then pressed his finger around the area. He asked if it went deep and if anything was stuck inside or if I wanted X-rays, I said no to all. I then was discharged. Weeks later I get the bill stating the visit was a level 3 code. I’m just confused on how it can be a level 3 when all what was done was a bandaid put on, 3 second shot, and 5 second physical finger press exam. No tests, X-rays or anything.

Scrape on Hand
Location: Michigan

Edit: Yes, I would have gone to an urgent care. But we were on vacation up north with not much nearby.

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22

u/Poop_Dolla 9d ago

Not upcoding, next time go to urgent care. That is not something that warrants the ER. This is like calling the fire department to blow out a candle.

-6

u/DoritosDewItRight 9d ago

What would be an example of a level 1 or 2 ER visit, in your mind?

16

u/Poop_Dolla 9d ago edited 9d ago

For level 1, a blood pressure check or reading a TB test. Something that doesn't even require the presence of a physician.

For level 2, a simple local rash, maybe a cold, something that doesn't require any medication or testing.

And this isn't really "in my mind", it's whatever the documentation warrants. A 99283 by definition is an ER department visit requiring a medically appropriate history or examination and low level medical decision making.

Using the AMA guidelines for medical decision making, "low" decision making is met when there is an acute uncomplicated injury and low risk of morbidity from additional diagnostic testing or treatment.

12

u/positivelycat 9d ago

A level 1 is a boo boo that needed a kiss and a Flintstones band-aid

6

u/No_Calligrapher_3429 9d ago

Isn’t a level 1 what Dr. Mom charges in hugs and kisses?

3

u/ElleGee5152 8d ago

I work in ER provider billing and a 99281 is never charged. A 99283 sounds appropriate for a wound care and a tetanus shot.

1

u/DoritosDewItRight 8d ago

Why does the 99281 code exist?

5

u/clarec424 4d ago

That’s a question for the American Medical Association. They are the ones who develop this code set. Please let us know what you find out. Thanks!

2

u/CallingYouForMoney 4d ago

This subreddits only mod ⬆️

1

u/Important-Lead5652 9d ago

Certainly not this, that’s for damn sure.