Wiki How do you bill postoperative recovery room or observation charges?

[RaeToll]

I have a UHC claim denial for revenue code 0710 for missing the associated CPT/HCPCS code. The patient underwent a septoplasty and was admitted to observation overnight, for which revenue code 0710 was billed without a CPT code.

I was thinking to remove revenue code 0710 and rebill with procedure code 99231 (subsequent hospital inpatient or observation) with revenue code 0987.
I truly appreciate any input or advice.

 

[thomas7331]

If the patient was admitted to observation status, then they’re probably looking for HCPCS code G0378 with the number of hours of observation in the units field.

99231 is for reporting professional services, not facility - that isn’t a correct code for the facility to report observation time.

 

[Bridgetln]

If the patient was admitted to observation status, then they’re probably looking for HCPCS code G0378 with the number of hours of observation in the units field.

99231 is for reporting professional services, not facility - that isn’t a correct code for the facility to report observation time

For the G0378 & G0379 those appear to be recognized/accepted by Medicare, Medicaid and BCBS. Do other payors recognize these codes and if they don't whats the alternative? Thank you!

 

[thomas7331]

For the G0378 & G0379 those appear to be recognized/accepted by Medicare, Medicaid and BCBS. Do other payors recognize these codes and if they don't whats the alternative? Thank you!

You would probably need to either review the payer's policies or check the facility's contract in order to answer that. Depending on how the facility is reimbursed, it may not even be necessary to submit a CPT or HCPCS codes with certain revenue codes.