Wiki Help with Revenue Codes

Create Wiki
1

1CodingTeam24

Networker
Messages
59
Location
Bolingbrook, IL
Best answers
0
Hello,

Im looking for any help on how to determine which Revenue codes goes with which CPT codes. Is there a crosswalk or anywhere I can look up that our CPT codes are being submitted with correct revenue codes?

Example:
for 52648 we are passing this with a 0490 revenue code.

Thanks for any help in this matter

Dana
 
There isn't a standardized crosswalk for this that I've ever seen. Revenue codes, as I understand them, are design for facilities to identify and report the revenue associated with their cost centers, and aren't for coding purposes in the same sense that CPT codes are. Some payers will have specific requirements for how they want the revenue codes used to ensure correct reimbursement, so you can check your contracts and the claims filing instructions of the specific payers you work with, but I don't know of any industry standard for specific CPT codes being assigned to certain revenue codes.
 
Rev Codes 450 for ER and Obs 762

If patient is seen in the ER and Rev Code 0450 is billed, but then patient is moved to an Obs status - does the Obs dept bill a 0450 with their 0762? We have instances of patients moving between the departments and the 0450 being charged by both providers.

Thanks for any help.

Tresa DiLuzio, CPC
Medical Claims Auditor
 
Observation is a patient status, not a department. Most facilities do not have a specific department or area within the hospital dedicated to observation - rather, the patient is kept in the ER, or the inpatient floor or other hospital area during the time they are in observation, so it would not be surprising to see it billed with 0450 if the patient was located in that area for a portion of their observation time. As long as the number of hours the facility bills and is paid for the observation matches the actual number that the patient was in that status during their hospitalization, I don't see the revenue code assignment as an issue.

Since revenue codes don't represent services performed in the same way CPT/HCPCS codes do (they are for facility 'revenue centers', or the departments where the facility wishes to associate those costs), I don't believe there is any coding problem due to associating an observation charge with a ER revenue center - that it really an internal matter for the facility. Some payers may have specific guidelines set up for how they wish the charges to be billed, or this may be stipulated in the provider's contract, but there are no correct coding rules that require particular codes to be assigned to specific revenue codes.
 
Last edited:
thomas7331 said:
Observation is a patient status, not a department. Most facilities do not have a specific department or area within the hospital dedicated to observation - rather, the patient is kept in the ER, or the inpatient floor or other hospital area during the time they are in observation, so it would not be surprising to see it billed with 0450 if the patient was located in that area for a portion of their observation time. As long as the number of hours the facility bills and is paid for the observation matches the actual number that the patient was in that status during their hospitalization, I don't see the revenue code assignment as an issue.

Since revenue codes don't represent services performed in the same way CPT/HCPCS codes do (they are for facility 'revenue centers', or the departments where the facility wishes to associate those costs), I don't believe there is any coding problem due to associating an observation charge with a ER revenue center - that it really an internal matter for the facility. Some payers may have specific guidelines set up for how they wish the charges to be billed, or this may be stipulated in the provider's contract, but there are no correct coding rules that require particular codes to be assigned to specific revenue codes.
Click to expand...

Thanks for your help.

Tresa
 
A year past and I'm posing another question on Rev Codes: Place of service 49 billed with 12 claim lines on one claim. All 12 codes are billed with Rev Code 0150 with no CPT code, just the 0150 and for different units and pricing. This type of billing is different from the POS 21, 22 that I normally see where the Rev Codes are very specific to what services are being billed. Can someone help me with one Rev Code being billed that many times and what it means?
 
You must log in or register to reply here.
Top