Wiki Rev Codes 360 and 370

[Anduiza05]

I am new to outpatient coding and billing I am confused on the OPPS edits for revenue codes. Does anyone know if revenue codes are bundled for example can you bill a rev code 360 and 370 on the same claim.

Also when the rev codes are billed with HCPCS codes do you know if the OPPS edits still apply.

For example
J2270 with Rev code 636
J2765 with Rev code 636

The OPPS edits have these codes bundled with other procedures but if it is billed with a Revenue code on a UB04 are they exempt from the edit.

I would appreciate any help
thanks

 

[CodingKing]

If i understand correctly under APC, there must be a CPT/HCPCS with a payable status indicator or it rolls up. So rev only will never pay under APC. For instance those 2 J codes are APC status N which means they are not separately payable and included in the APC payment of the procedure they are being used for.

 

[thomas7331]

With outpatient facility billing, bundling can be a confusing concept because charges can be bundled for payment, but that is different from being bundled from a coding standpoint. I'm not sure which edits you're referring to though - OPPS edits can be for a lot of different reasons.

NCCI edits do apply to outpatient facility claims, but they apply to the CPT and HCPCS codes used, not to the revenue codes. For those edits, you would follow the coding guidelines in a similar way as you would for professional coding and apply modifiers is allowed and appropriate, and not separately report mutually exclusive or incidental procedures. On OPPS claims, if you unbundle inappropriately, it will usually cause the entire claim to fail, unlike on a professional claim where it will cause a single line to be denied.

Bundling for payment is a different concept - in OPPS, certainly lines will receive payment (e.g. your revenue code 360 for an outpatient surgery claim) and this will be an all-inclusive payment for the claim. Other lines (e.g. revenue code 370) will not have a line item payment, but this does not mean that they are being denied for bundling, it's just that the payment on another line encompasses that charge. It does not mean that you should not bill that line or that code - you still need to report your facility's charges for those services even though there is not a separate payment. The single line item payment you are receiving takes into account everything on the claim, so you don't want to omit charges simply because it doesn't look like they're getting paid.

Not sure if this helps some - if you could give a little more detail about the edits you say you're getting it might be more clear what's going on.