Coding mess, please help!

I went to the ED due to numbness, especially loss of pain and temperature to my extremities. I was seen by the ED doc who said it’s nothing worth doing a more thorough neuro work up and just ordered bloodwork before discharging.

I got a bill from the ED which I paid right away. Looking more closely at the itemized bill, they charged CPT 80307 10 times and CPT 99283 for a ER visit level 3. I got suspicious when I received another bill from a third party billing company (EMBCC) only saying “provider charge”, I assumed he was contracted and sending his own bill. When I called the insurance company to ask how the provider billed, she said with CPT 99284, although also kept insisting it was only billed once (not by the hospital). Apparently she said the hospital billed CPT 0450, which was not on my itemized bill. I called the ED private practice to get more information about their bill, they said they don’t have an account under my name, they’re not contracted with the billing company who sent the bill, and that ED no longer works with them for many months now.

My questions are why is there a discrepancy between the itemized bill from the ED and what the insurance is saying what CPT codes were used (the EOB does not include specific codes but charges match itemized bill). What do I do about this provider bill?

I would appreciate any help 🙏 thank you!

submitted by /u/Basic-Tangerine7026

See also  UPDATE: Is this fraud?