ER Visit (level 3)

What it is

Level 3 is the centre of gravity of emergency billing. It is the code applied to the ordinary emergency visit: something was wrong, it needed sorting out, a few tests were run, and the answer turned out to be manageable at home. What separates it from the levels below is that more than one possibility had to be held open and something had to be done to distinguish between them. What separates it from the levels above is that none of those possibilities was an immediate threat.

The level is not a triage category and is not assigned at the desk. A coder reads the physician's documentation afterward and derives the level from the complexity of the decision-making it describes — how many problems were addressed, what data was reviewed, and how much risk the situation carried. That is why two people who spent the same six hours in the same department can be billed at different levels, and why the level is something you learn from the bill rather than from the visit.

Why it is done

• Abdominal pain, chest discomfort or a headache that needed testing before a benign cause could be settled on
• An injury requiring an X-ray, a laceration needing repair, or a suspected fracture that turned out to be a sprain
• A fever or infection needing labs and a decision about whether antibiotics and home care were enough
• An acute flare of a known condition — asthma, back pain, a kidney stone — treated in the department and discharged
• Symptoms that were worrying enough to justify emergency evaluation and turned out not to be dangerous

What to expect

Triage first, then a wait whose length depends on who else is in the department. The evaluation typically includes a physician or advanced practice clinician taking a history and examining you, followed by some combination of blood tests, urine tests, an electrocardiogram or plain imaging. Treatment may be given in the department. Most level 3 visits end in discharge with instructions and a referral back to a primary care doctor or a specialist. Results of anything still pending, such as a culture, are followed up afterward.

Questions worth asking

• The visit code covers the evaluation only. Each lab, X-ray, EKG and medication given is billed on top — ask for the itemized bill, not the summary.
• Ask how the level was determined and whether a coding review can be requested. Level 3 sits between two neighbouring codes at meaningfully different prices, and downcoding disputes are a common billing issue.
• If imaging was done, a radiologist's reading is a separate charge from a separate provider. Ask whether that provider is in your network.
• If a pending culture or blood test comes back later, will that generate a second bill for the follow-up call or repeat visit?
• Ask the hospital what its self-pay or financial-assistance price is for this visit level if you are uninsured — emergency departments are required to have a written policy, and the list price is rarely what is collected.