ER Visit (level 2)

What it is

Every emergency department visit generates a charge for the visit itself, separate from any test, scan, drug, or procedure. That charge carries one of five levels, and the level is what this code records. Since 2023 the level is set by one thing only: the complexity of the medical decision making — how many problems were in play, how much data had to be gathered and interpreted, and how much risk was attached to the situation and its management. How long the visit took and how detailed the written history was no longer determine the level. Level 2 sits toward the lower end of that scale, describing a visit whose decision making was straightforward.

Why it is done

• To record the clinician's evaluation of someone who came to the emergency department without an appointment
• To distinguish a visit with straightforward decision making from one involving several problems, more data, or higher risk, which would carry a higher level
• To bill for the assessment itself, separately from any imaging, laboratory tests, or procedures done during the same visit
• To document the work of sorting out what is wrong, including the reassurance and discharge of someone who turns out not to need treatment

What to expect

Arrival is followed by triage, where a nurse takes vital signs and decides how urgently the patient needs to be seen; patients are called in order of how sick they appear rather than in order of arrival. A clinician then takes a history, examines, and decides whether tests are needed. A level 2 visit generally corresponds to a problem resolved without much testing or much uncertainty, ending in discharge with instructions. Note that the hospital also assigns its own level to the same visit for the use of the room, the nursing, and the supplies, using its own internal criteria — so the visit itself commonly produces two charges before anything else is added.

Questions worth asking

• Will I get two bills for this visit — one from the hospital for the facility and one from the emergency physician group — and are both in my network?
• What level did each of those two bills use? The hospital's facility level and the clinician's level are set separately and do not have to match.
• Can I have an itemized bill showing the visit charge apart from the charges for any imaging, labs, or medications given?
• Were the radiologist, the pathologist, or any consulting specialist part of separate groups that will bill me on their own?
• What protection do I have against balance billing for an emergency visit if a clinician who treated me was out of network, and who can I ask to apply it?