• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below.
  • We're introducing new features and a new look to make the forums easier to use and more valuable to you. See what's new and let us know what you think!

ER E&M upcoding

Lisa Cato

Best answers
We have a provider(Hospital) that routinely upcodes Emergency room E&M codes using 99285. Documentation clearly does not support the billing of the code and the provider refuses to lower the code or the charges. The provider in turn bills the patient for the charges since we, the auto insurance company won't pay for the services/treatment where documentation isn't supporting the billing. How can this be handled appropriately? We don't want the patient balance billed for a service that wasn't rendered. Is there an organization where a formal complaint can be filed?


True Blue
Columbia, MO
Best answers
to bill for services not provided is fraud, check with you states attorney generals office or if you have a state board of healing arts or the equivalent.