Must-Know List of Revenue Codes for Medical Billing

What is the list of revenue codes for medical billing that you can count on right now? 20? 30? Or at least 10? Oh yeah, Not so possible to reveal it right now! Then how do you memorize it? Fine, that’s not simple either. Medical coding has been a complex process always. Whenever a new code pops in, it becomes challenging for professionals to figure out the actual place to use them and whether they should add the codes along with any modifiers. The list of revenue codes for medical billing, no doubt, will help make the process smoother and easier or less complicated.

People new to this area might wonder the difference between revenue codes and the others. Revenue codes are used in Hospital Billing Services. The list of revenue codes for medical billing conveys to the insurance payer either where the patient was or when they received treatment or what type of equipment a patient might have received. If this goes missing from the claim, then the provider has to forget about his reimbursem*nt. These codes also reveal if the procedure was performed in an operation theatre, emergency room, or another place.

This article brings you a detailed study on the list of revenue codes for medical billing, which is necessary to enhance your business profits.

Understanding the list of revenue codes for medical billing:

Alright! Getting into the basics of revenue codes, you can use these 4-digit codes on hospital bills to convey or reveal to insurance payers where the patient existed while receiving the treatment.
It also includes the type of equipment or item that the patient has received during the procedure.
However, hospitals run on three different codes. They include:

ICD-10: for diagnoses
CPT: for procedures
HCPCS: for medical goods and services.

When the list of revenue codes for medical billing is attached to the supply codes, they identify if the equipment was used in the hospital or taken home by a patient.
This is extremely important because most of the procedures performed in the hospitals are done in different areas.
For instance, the stitches are done in an emergency room or other designated area in the hospital, such as the maternity ward.
Of course, it depends on the procedure performed, and the price for the procedure can be entirely different too!

Revenue codes on UB-04:

The list of revenue codes for medical billing is located in various areas on UB-04 forms. UB-04 is the billing form used by hospitals and other healthcare professionals.
The significant purpose of these codes is to group similar charges onto one line in the form.
Please keep in mind that you cannot report revenue codes on a CMS-1500 form but can report them on a UB-04.
So, for those insurance companies, for whom UB-04 forms are submitted, you can reveal your charges and bill for few ancillary services, like supplies.
A valid procedure code should be accompanied by a revenue code so that the insurance companies accept it.
There are almost 81 fields in the UB-04 form, and revenue codes are located by fields 42-49 (FL42-49).
This list of revenue codes for medical billing companies was developed for the Medicare system but soon were adopted as standard codes for the hospitals and healthcare organizations.
Revenue codes have to go along with the procedure codes. While arranging them in the chargemaster, you probably should add the correct revenue code to the CPT code you were going to use for a particular department.
It is the use of revenue codes that allow hospitals to use the same CPT code in multiple departments as it shows which department the services were rendered to the patient.

List of revenue codes for medical billing:

0001: Total Charges

001X: Reserved for internal payer use

002X: Health Insurance Prospective Payment System (HIPPS)

0020-0021 Reserved

0022 – Skilled Nursing Facility (SNF) PPS

0023 – Home Health PPS

0024 – Inpatient Rehabilitation Facility (IRF) PPS

0025-0029 – Reserved

Health Insurance Prospective Payment System (HIPPS) rate codes represent specific sets of patient characteristics, and healthcare insurance payers use them to make payment determinations under several prospective payment systems.
These revenue codes mentioned above include reserved skilled nursing facility, home health PPS, and inpatient rehabilitation facility.
These HIPPS codes are mentioned or reported on the claims to the insurance companies.

010X

All-inclusive Rate

0100: All-inclusive room and Board plus ancillary

0101: All-inclusive Room and Board

011X

Room and Board Private (one bed)

Revenue Codes in Medical Billing: An In-Depth Analysis

1. Purpose and Importance of Revenue Codes:

Evidence: Revenue codes, represented by 4-digit codes on hospital bills, play a crucial role in conveying information to insurance payers about the patient's location during treatment and the equipment used.
Expert Insight: Missing revenue codes in a claim can lead to reimbursem*nt issues for healthcare providers.

2. Types of Codes in Hospitals:

Evidence: Hospitals utilize three main code sets - ICD-10 for diagnoses, CPT for procedures, and HCPCS for medical goods and services.
Expert Insight: When linked to supply codes, revenue codes identify whether equipment was used in the hospital or taken home by the patient.

3. Revenue Codes on UB-04 Forms:

Evidence: UB-04 is the billing form used by hospitals, and revenue codes are located in fields 42-49.
Expert Insight: Revenue codes on UB-04 forms were initially developed for the Medicare system but became standard for hospitals and healthcare organizations.

4. List of Revenue Codes for Medical Billing:

Evidence: The provided list includes examples like 0001 for total charges, 001X for internal payer use, and 010X for all-inclusive rates.
Expert Insight: Revenue codes, such as HIPPS codes (e.g., 002X series), convey specific patient characteristics for payment determinations.

5. All-Inclusive Rate Codes (010X):

Evidence: Codes like 0100 represent all-inclusive room and board plus ancillary services.
Expert Insight: These codes specify different types of room and board services, crucial for billing accuracy.

6. Room and Board Codes (011X - 015X):

Evidence: Detailed breakdowns for private, semiprivate, deluxe private, ward, and other room and board services are provided.
Expert Insight: Revenue codes distinguish the level of accommodation and care, impacting billing and reimbursem*nt.

7. Other Room and Board Codes (016X):

Evidence: Codes under 016X cover various room and board scenarios, including sterile, self-care, and other.
Expert Insight: These codes further specify the nature of the room and board services provided.

8. Extensiveness of Revenue Codes:

Evidence: The article emphasizes the extensive nature of revenue codes and promises a continuation in the next installment.
Expert Insight: Acknowledging the vast array of codes underscores the complexity of medical billing and coding.

9. Stay Informed for Coding Updates:

Evidence: The article encourages staying updated on coding changes in 2021 and subscribing to the blog for industry news.
Expert Insight: Continuous learning and staying informed are crucial in the dynamic field of medical coding and billing.

In conclusion, mastering the list of revenue codes is essential for healthcare professionals to navigate the complexities of medical billing, ensuring accurate reimbursem*nt and a smooth revenue cycle. Stay tuned for the latest updates and advancements in the ever-evolving landscape of medical coding.

Must-Know List of Revenue Codes for Medical Billing - Qway Health Care (2024)