Revenue codes

jfitzgerald@hcpro.com

Do revenue codes have standard meanings for all payers? We are finding that payers are telling us to use different codes than we would normally use for Medicare.

trinker

We have the same issue.  If it is in the payers claim processing manual (and it usually is) or if the other payer can provide us with something in writing, we use what the particular payer requests.

RHirsch

Imagine if any other industry operated this way. In Ford cars, the gas pedal is the right one. In GM cars, it is the left pedal. In Chrysler, you brake by turning the steering wheel and steer with your feet. It's lunacy!

mcohen@blr.com

Thanks, Terry and Dr. Hirsch. This is great information!

kbaker@hcpro.com

Just a note about standardized use of revenue codes.  Revenue codes are part of the standard transaction sets adopted by HIPPA.  The NUBC manual contains the standard definitions for revenue codes.  The official electronic version of this manual is available from the AHA and every business office should have access even if they have an editorial version of the codes from another source.  In addition to the standard definitions manual, the electronic version comes with an extensive archive of NUBC committee minutes that provide helpful background for some codes/code sets.

That said, payers should be using the codes according to their standard definitions and if you find they are not, you can bring it to their attention and if they do not correct, there is a method of reporting a violation to the OCR - not that it will come to that, but that is a method to enforce compliance. One of the problems I've found is that the definitions are so general that the two codes CMS and the payer are using may both fit and each payer has established their own edits that require the code they are instructing you to use.  However, your system should be able to translate these in the background by payer type once you identify the code required (which I know is the big challenge).  Good luck!

debs0906

When we have had a payer that asks for a different rev code than Medicare or often the majority, we ask our payer contractors to work with them to get them in line with the majority. Doesn't always work, but we have had some success.

joliver1959

what revenue code does everyone for the administration of the IM/SQ injections?  I am new to the chargemaster and I have a charge in 260 and 1 in a 940.  The rev code 260 is for IV Therapy and the 940 is other therapeutic services.  I may be over thinking this but according to the NUBC rev 260 is administration is for administration of intravenous solutions. 

kay.larsen@ah.org

We have 96372 mapped to 0940 except for ED, where it's mapped to 0450

kellieperkins

Wondering what best practice is for categorizing supplies vs. implants.  We have been using FDA categorization although experiencing issues with payers because sutures are categorized as implants.  Thanks!