Hospitals like to slip expenses under your radar, fudge the system to overcharge you, and hide from you the Charity Care you’re rightfully owed, but sometimes, strange actions from the hospital have a valid explanation.

In this article, you’ll get answers to four of the most common questions about hospital bills, plus a bonus! By the end of this article, you’ll learn:

• Why you had to pay so much, only to be discharged with only a minor diagnosis

• What ‘ER Visit Levels’ are - and what they mean

• And a lot of new CPT codes!

Why Did I Get Two Bills?

Hospitals send two bills to every patient. The institutional bill typically arrives first, with the physician bill following it. Receiving two bills is standard in the healthcare system.

The first bill, known as the institutional bill or the facility bill, charges for the procedures and tests, as well as the administrative costs of the hospital. For example, if you receive an X-Ray, you’ll receive hospital charges for the operation of equipment. This first bill typically costs more than the second.

  Called the professional bill or the physician bill and charged separately, the second bill exacts the cost of more specialized work. In the X-Ray example, the physician bill will charge you for the time and expertise of the doctor who ran and analyzed your X-Ray.

Why Did My Minor Diagnosis Cost So Much?

The short answer to this question reads that hospital charges are more associated with your symptoms than they are with your diagnosis. For example, if you enter a hospital complaining of severe gastrointestinal pain, there are a lot of tests the doctors might have to run, depending on your specific symptoms. They might have to test you for appendicitis, gallstones, or infection, and that testing can cost a lot.

Whatever the diagnosis says, even if it simply says ‘stomach ache,’ the hospital charges you for the tests. In other words, the process of hospital pricing does not stem from the real issue, it stems from the possible issues they test for, and those come from your symptoms.

Symptoms lead to testing. which incurs the cost, which leads to diagnosis.

What Are ‘ER Visit Levels’?

If you’ve been in the Emergency Room, you might have overheard facility employees mentioning something called ‘ER Visit Levels.’ Ranging from level one to level five, these levels simply explain the intensity of a situation. Lower levels are milder, while ER Visit Level 5 is the most severe. The typical ER Visit Level is level four.

Each ER Visit Level correlates to a CPT code. Level 1 connects with CPT 99281, Level 2 with CPT 99282, Level 3 with CPT 99283, Level 4 with CPT 99284, and, finishing the neat sequence, Level 5 with CPT 99285.

How are ER Visit Levels determined? Before the patient reaches them, the more severe levels have certain requirements.

• The milder levels, like Level 1 or Level 2, are characterized by relatively insignificant maladies, such as bug bites and sunburns.

• Level 4 requires two diagnostic tests (i.e., EKG, lab, or X-Ray), or administration of fluids through intravenous therapy (IV therapy) via a catheter, or a venipuncture, or blood draw. 

• Most intensely, Level 5 requires three or more diagnostic tests, or an imaging scan where a patient is injected with contrast material (such as a CT scan or MRI), or other prerequisites.

Why Was I Charged For A Pregnancy Test?

Simply put, it’s too risky not to test pre-menopausal women for pregnancy, because some treatments are harmful to unborn babies or pregnant mothers Usually, the hospital will bill the pregnancy test as “human chorionic gonadotropin (hCG),” which is hormone testing.

The CPT codes associated with pregnancy testing fall into two categories:

• CPT 84702 or 84703 for blood test

• CPT 81025 for urine test

Other Common Questions

What’s a metabolic panel? Metabolic panels are a single blood draw that performs numerous tests. Two types exist, regular metabolic panels (CPT 80048) and comprehensive metabolic panels (CPT 80052), the latter of which tests more extensively. 

What’s venipuncture? Venipuncture is blood vessel access through a needle. This can be for IV therapy or a venous blood sampling. Its CPT code is CPT 36415.

What’s lipase? Lipase measures the enzyme of the same name, which helps to break down fat in your intestines. This is particularly relevant if you have pancreatitis, an inflammation of the pancreas gland, which can elevate lipase levels. Receiving lipase falls under CPT 83690.

I don’t see any CPT codes on my bill. How can I access them? CPT codes are the common language across every hospital to describe certain health procedures. You can request an “itemized bill” from the hospital, which gives line-by-line breakdowns of each charge with each CPT code. To learn more about CPT codes, read this article, which is all about them:

Conclusion

Now your questions have been answered, and hopefully, the hospital bills make a little more sense now. To recap, two bills is normal practice; ER Visit Levels are shorthand descriptions of the severity of your malady; you’re charged for testing, not diagnosis; and if you’re female, it’s standard to have a pregnancy test. Plus, we threw in a few bonus facts for you!

We hope this article answered all your hospital bill questions! At Fairdoc, we are here to inform you, assist you, and answer all your questions. If you have any questions for us, feel free to reach out, and stay tuned for future articles!