Question Therapeutic Injections and Pushes

k61756p

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Hello, I need some assistance. Auditing some claims. I have a facility billing only two charges (outpatient) on the (UB04) claim. Line 1 is the therapeutic drug billed with Revenue Code 0636 and then line 2 is CPT 96365 with revenue code 0940. Is line two billed correctly with revenue code 0940 (general other therapy services?) I would think the more appropriate revenue code should be 0260 (General IV Therapy.)

Thanks in advance..
 

thomas7331

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Unlike CPT and HCPCS codes, revenue codes are not used primarily for purposes of reporting services, but are for facilities to internally track their cost centers, so are not subject to the same kinds of correct coding rules as are codes that actually report individual services or supplies. Unless otherwise specifically required by a payer policy or contract, facilities are largely allowed to assign revenue codes as they choose. For CMS purposes, outpatient facility claims are priced based on the CPT and HCPCS codes reported, so whether revenue code 0940 or 0260 is used would not affect the payment calculation. For commercial plans, you would need to review the payer's rules and the terms of the contract in order to know if the facility was reporting or being paid incorrectly by using one revenue code versus another.
 
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