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Revenue code, CPt code and MOdifier

  1. #1
    Default Revenue code, CPt code and MOdifier
    Medical Coding Books
    Hi all,


    I would like to know how CPT code, Revenue code and Modifiers are related.

    Is it mandatory to have CPT code and revenue code both billed together and submit to the insurance.

    What if only revenue code is sublmited to the insurance without having the CPT code.

    Thanks for youyr reply in advance
    Thank you,
    Meera Mohanakrishnan, MSc, CPC, COC, CPC-P, CRC (Risk Adjustment), CCS (AHIMA) ,CPC- I (AAPC Approved Instructor) , Certified ICD 10 Consultant, PAHM |
    Director – Medical Coding Operations and Training

  2. Default
    Hi Meera,
    Cpt and Revenue codes are realted in determining the coverage,
    Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes. It is not possible to submit only revenue code with out CPT.

  3. #3
    Columbia, MO
    For Outpatient facility billing the revenue code and the CPT code are very much related to each other. The federal regisiter and the UB04 billing manual describes this relationship in that in certain revenue centers only certain CPT codes may be used. There is also an edit in the oupatient code editor which will return a line item not paid if the the CPT code is not in the correct code range for a specific revenue center. If you are coding for a facility outpatient you must be very aware of the rvenue centers and this relationship. A line item with a revenue center and no CPT will not reimburse, and a CPT with no revenue center attached will not reimburse.
    Debra Mitchell, MSPH, CPC-H

  4. Default
    Please give an example of CPT & Rev code for HHA!
    Thank You

  5. Default
    I'm very interesting in Home Health Agency Coding!
    How do I even begin to look up the CPT(E/M) codes?
    Are there seminars or books I can read?

  6. #6
    Columbia, MO
    You need a CPT book for all your E&M and procedure codes, and ICD-9CM volumes 1 and 2 for your dx codes. You will use rev codes only if youare using the UB04. If you are billing on a CMS 1500 you will not need rev codes.

    Debra A. Mitchell, MSPH, CPC-H

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