Sample analysis — ER visit, June 2026
Regional Medical Center · Date of service: 06/14/2026
Summary
This ER bill contains at least one clear duplicate charge and appears to be upcoded from a moderate-severity visit to a high-severity visit. Two additional items (supplies and injectable pain medication) are priced well above typical rates. Estimated recoverable amount is $1,355 through a combination of billing corrections and negotiation.
Red flags
- duplicate chargehighChest X-ray (71046) billed twice on the same date of service.
- upcodinghighED visit billed at level 4 (99284) but documentation appears to support level 3 (99283).
- unbundlingmediumSupplies (A9270) billed separately from the ED visit — typically these are bundled into the visit code.
- above market ratemediumKetorolac (J1885) charged well above typical AWP; worth negotiating.
Line items decoded
| Code | Description | Amount |
|---|---|---|
| 99284 | Emergency department visit, high severity Level 4 ED visit. Documentation supports level 3 (moderate severity) based on the described complaint — potential upcoding. | $2450.00 |
| 71046 | Chest X-ray, 2 views Standard 2-view chest X-ray. Amount is above the typical negotiated rate for this region. | $480.00 |
| 71046 | Chest X-ray, 2 views Appears twice on the itemized bill for the same date and time — likely duplicate charge. | $480.00 |
| J1885 | Ketorolac injection, 30mg IV pain medication. Charge is roughly 6x the average wholesale price for this drug. | $185.00 |
| A9270 | Non-covered supply Generic supply code — often used to bill routine items (gloves, gauze) that are typically included. | $42.00 |
Sample appeal letter
Regional Medical Center Billing Department
Re: Account #XXXX-XXXX · Date of service 06/14/2026
To Whom It May Concern,
I am writing to request a review and correction of the itemized bill referenced above. After reviewing the charges, I have identified several items that appear to be incorrectly billed:
- Duplicate charge: CPT 71046 (chest X-ray, 2 views) is billed twice for the same visit. Please remove the duplicate $480 charge.
- Upcoded ED visit: The visit is billed as CPT 99284 (high severity). Based on my recollection of the encounter and the documented complaint, I believe CPT 99283 (moderate severity) is appropriate. Please review and adjust.
- Unbundled supplies: Code A9270 for routine supplies is typically included in the ED visit charge. Please remove or bundle.
Please send me a corrected itemized statement reflecting these adjustments within 30 days. If you dispute any of these items, please provide the supporting documentation.
Thank you for your prompt attention to this matter.
Sincerely,
[Your name]
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