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A patient came into our office from an ER visit she had a few days ago. The ER doc diagnosed her thumb as fracture. However our Ortho doc found it to be a sprain, not a fracture. Can the ER doc bill fracture care even if there was no fracture?
Did you ask you see the ER bill? It might be a bit too soon for her to have one? No the ER shouldn't bill it as a fracture unless the X-Ray was read as a fracture and confirmed by radiology. But ERs will often code finger fractures and typically splinting is definitive care for finger fractures. So this could have been an error based on X-Ray interp at the hospital. Jim
Hi Jim. She (a relative) looked online at a pre released EOB. She got the EOB for an x ray doc,which matched the bill. So we have concluded that the bill will be the same as the EOB. I was also with her during her ER visit. The ER doc came and said it was a FX and showed her the x-ray. They also gave her a splint.
I mean, they billed for an x-ray md and the x ray on a separate claim. Plus they also billed outpatient for meds and such. Hospital billing is confusing and I'm trying to help her out before she calls their billing service. Any help is appreciated.
That looks about right. I've seen ER bills for close to $2000 for finger fractures between the ED docs and hospital charges. Usually 75% or more of the $2000 is on the hospital side. It looks like both the ED docs and hospital radiologists interpreted the injury as a fracture. Why did your office differ on the interpretation? I'm guessing your Ortho did their own X-Ray and didn't see the fracture? This is one reason why there has been a long standing debate between ED and Ortho about fracture care in the ED.
But it looks on surface like the billing was appropriate based on the information they had at the time. Looks like she was billed for ED physician and hospital services as well as (I think) a separate bill for radiology. That's pretty much how it works. But if she or you want to dispute the bill, she can request a copy of the radiology X-Ray interp. I believe she or your practice could request a copy of the X-Ray. If there was no fracture, they should revise the bill to a Level of service (hospital and ED), supplies, radiology as well as probably for splinting of the sprain in the ED. Believe it or not it might not be much cheaper. Makes you think twice and apply ice the next time you injure your finger!