Revenue Code 200 ICU

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Hello thank you in advance to any response I receive to this question. I am CPC who deals primarily in Professional coding and billing for my daily work. I'm trying to learn a little more about facility coding to aid a friend who had spent some time in the hospital recently. This individual was billed for revenue code 200 ICU, 24 consecutive days. What I am trying to calculate is what Medicaid's allowed amount would be for those charges. This took place in Columbus, OH. What information do I need in order to calculate this? Thanks again.
 

CodingKing

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Looks like they pay off of a APDRG System. I don't think you are going to be able to figure this out. I'd suggest contacting Medicaid to figure it out.

You would need to know the diagnosis codes in order to figure out the DRG it falls under.
You also need to know the severity of illness code.
A stay this long is probably going to be more complicated than a standard stay due to outlier payments (You wont be able to figure out the hospitals cost to charge ratio)


The rate is the (RVU for the DRG) x the base rate + any outlier payments



http://www.medicaid.ohio.gov/PROVID...roviderInformation/HospitalPaymentPolicy.aspx

Then of course there are hospitals that are exempt from the APDRG system and are paid on a reasonable cost basis
 
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