Medical Bill Auditor — $$$ back in your pocket for $?

[Date] Mercy General Hospital — Billing Department Re: Account #MG-88214 — request for corrected itemized statement Date of service: 06/02 (ER visit) To the Billing Department: I have reviewed the itemized statement for account #MG-88214 line by line and am writing to dispute several charges before I pay. I am not alleging any intent; I am asking you to verify each item below against the medical record and issue a corrected statement. 1. Duplicate — CPT 80053 (comprehensive metabolic panel) appears twice, both dated 06/02, at $445.00 each. A metabolic panel is billed once per blood draw. Unless the record documents a distinct repeat draw (which would carry a modifier such as 91), please remove one line — a suspected reduction of $445.00. 2. Unbundling — CPT 82947 (blood glucose), $92.00, is billed on the same date as CPT 80053. Under CMS National Correct Coding Initiative (NCCI) Procedure-to-Procedure edits, a blood glucose is a component of the comprehensive metabolic panel and is not separately payable unless a modifier documents a distinct service. Please confirm the pairing and either remove the $92.00 charge or provide the modifier and documentation supporting it. 3. Implausible units — HCPCS J7030 (sodium chloride 1000 mL IV) is billed at 22 units for $528.00 ($24.00 per unit). Twenty-two units is twenty-two liters of saline for a single ER visit, which is clinically implausible and points to a keying error. Please confirm the units actually administered per the record; correcting to a typical 2 units ($48.00) would be a suspected reduction of about $480.00. 4. E/M level — CPT 99285 (highest-level ER E/M, level 5), $1,890.00. Please confirm the documentation supports level 5 (high-complexity medical decision-making) rather than a lower level; if it does not, the level and charge should be adjusted. 5. HCPCS Q9967, billed as "Ibuprofen 200mg tab" at 30 units for $210.00 ($7.00 per tablet). Thirty tablets on a single ER encounter is unusual for an administered medication, and the code should match its description. Please verify the code, description, and quantity billed against the record. 6. Itemization gap — the six line items shown total $3,610.00, but the balance due after insurance is stated as $6,142.00. Please provide a fully itemized statement showing every charge that makes up the balance, along with the Explanation of Benefits, so the $2,532.00 difference can be reconciled. Items 1–3 represent a suspected reduction of approximately $1,017.00, pending verification; items 4–6 are flagged for you to verify against the record and the EOB. Please issue a corrected itemized statement, pause any collection activity while this good-faith dispute is open, and provide the Explanation of Benefits if it has not already been sent. [Patient name] [Contact information]