Understanding Medical Billing and Revenue Codes - Outsource Management Group, LLC. (2024)
Not all medical billing is generated from physician’s services. Sometimes services are rendered to patients and the medical billing created from those procedures need to be submitted to the various insurance carriers, but they also need three things: a price, a procedure code, and a revenue code.
Revenue codes indicate to the type of service that you are billing for; revenue codes are 3-digit codes, and those revenue codes must match up with specific procedure codes to designate what services were rendered.
For instance, if you are using a 360 revenue code, you’re stating that the services rendered were performed in the operating room, and therefore, the procedure codes that match up with it need to be between 10000 and 69999, which are the surgical procedure codes range. Radiology and all its different incarnations are between 320 and 350, with ultrasound in the 400 range; labs are 300 – 319, and so forth.
Revenue codes go from 000 through 999, though many codes aren’t applicable across the board, and not all of the numbers are generally used. For instance, the lower numbers denote hospital inpatient rooms, and the highest numbers denote patient convenience items while they’re inpatients.
Some procedure codes can match up with multiple revenue codes, depending on where the service might be performed. For example, endoscopic surgical procedures can go against 360 for operating room, 450 for emergency room, 490 for ambulatory surgery center, and 750 for endoscopy, because it depends on where the service has taken place. Then, in another instance, no matter where lab services are performed, their codes are always between that 300 – 319 range.
In short, Revenue Codes are descriptions and dollar amounts charged for hospital services provided to a patient. The revenue code tells an insurance company whether the procedure was performed in the emergency room, operating room or another department.
Right now, there are five major types of medical coding classification systems that are used by medical coding professionals — ICD-11, ICD-10-CM, ICD-10-PCS, CPT and HCPCS Level II. If you're interested in becoming a medical billing and coding professional, it's important to learn more about each system.
Revenue codes are used along with procedure codes like CPT codes (and sometimes HCPCS codes). It is because there are various procedures that may be performed either in an emergency room or operating room. In such a case, the procedure code (CPT/HCPCS) remains the same but the revenue code varies.
What are UB04 Revenue Codes? This form, also known as the UB-04, is a uniform institutional provider bill suitable for use in billing multiple third party payers. Because it serves many payers, a particular payer may not need some data elements.
CPT® code 99213: Established patient office or other outpatient visit, 20-29 minutes. As the authority on the CPT® code set, the AMA is providing the top-searched codes to help remove obstacles and burdens that interfere with patient care.
There are several ways revenue code 250 can be used for billing outpatient medications. The first pertains to billing for a covered medication which does not have a valid HCPCS or CPT code. In this instance, revenue code 250 may be billed without a corresponding code.
Revenue Codes – Four-digit numbers used on hospital claims that let the health plan know the treatment received, or the type of item received by the patient. 0170 - General Nursery or Well-Baby Nursery. 0171 - Newborn level 1. 0172 - Newborn level 2. 0173 - Newborn level 3.
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