Telemetry Revenue Code
Is there a general consensus on the appropriate Revenue Code for telemetry monitoring? The patients are monitored however not on a designated floor/unit. Is 214 appropriate in this situation? Was wondering how other hospitals are handling? I have heard of RC 121 for room & board then applying the telemetry charge in RC 732 but this is a manual process. Thank you in advance for the discussion.
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I am new to NAHRI and looking at the forums. I don't see anything here since 2018 - did the conversation just die out? NUBC definitions note that this is a level of service higher than med-surg unit. The description of the rev code blocks for 20x and 21x include the word "unit", which to me, means a defined space where a more intensive level of care is provided, staffing ratios are lower to accommodate this increase in acuity and staff training should be higher. I have a clip from NUBC for rev 021x that says "report when a discrete coronary care unit exists for rendering such services." Which again, points to a unit/location and not just a med surg patient on telemetry. Additionally Interqual does not consider telemetry a level of care. I believe that CMS has also stated that a patient can be in ICU on monitors and still be considered outpatient, which also seems to negate the use of telemetry as a qualifier for the 02x RC in a non-designated specialty care location. Any updates?
Appreciate that @kimsegal . The thread had died a quiet death.
Yes, I was afraid of that. Maybe I'll start a new one. :)
Typically, telemetry is viewed as a service that is part of a room rate. This can be expressed in different ways, as we know that there are revenue codes to represent different types of room accommodations. While revenue code 0732 is defined by NUBC as "Telemetry," it requires that a HCPCS code be reported. Because telemetry monitoring does not have a CPT code, it is very difficult to specifically represent this service on an OP claim. When the patient is an inpatient, you can represent the increased cost of the telemetry in the room and board charge, or if the unit can support multiple types of services (e.g., monitored vs non-monitored), you can report the additional cost of telemetry under revenue code 023X depending on the type of unit. Payers view this as part of the room and board. The downside is that it is not specific to telemetry so the claim won't reflect this. It sounds like with the LTACH requirements, etc., there should be a request placed to NUBC to create a way for this to be reflected on the claim when 020x and 021x are not applicable.
HI All - I would like to take a poll on how folks are reporting their revenue codes for telemetry inpatients in an acute care hospital setting across various floors/units.
I'm getting conflicting information from consultants and vendors on using 206 vs 210 or 214. Patients are not in ICU but 206 is being recommended as the appropriate care level for someone with an accommodation of telemetry, regardless of the unit. Some payers disagree and are refusing to pay when revenue code 206 is used and the patient is not in ICU. Would love to hear your thoughts and understand how other facilities are managing this. Is anyone using 732 or 203x as suggested above?
I was just discussing this topic with some attendees at the 2023 Revenue Integrity Symposium. The answer is either 206 or 214 are allowable - the key is having criteria written in a formal policy that are clinical and will be documented in each's patients chart. Orders for telemetry and the documentation of the telemetry services would count, but other elements may apply such as current/previous cardiac condition, medications with cardiology risks, etc. Then because both 206 and 214 are in the revenue code ranges for specialty care areas, it is important to check whether the unit meets all the criteria in Section 2202.7 of the Provider Reimbursement Manual Part 1 - if not, then the expense/cost center for this unit should map to the regular medical/surgical/routine cost center(s) in your hospital's cost report. If all the criteria in section 2202.7 are met, then the costs can be reported as a specialty care unit in the cost report.
Also, you can have more than one room price with the same accommodation revenue code as long as it is in a formal written policy and is tied to clinical resources that are documented and represent more costs. For example, I recommend 3 levels of accommodations for medical/surgical and ICU - the default/general accommodation rate that is your basic rate, a rate for isolation precautions supported by the clinician's order for isolation precautions and this ends when the order is ended and finally, what I called a therapeutic room rate that the policy was if the patient needed a specialty bed/mattress and/or had a BMI greater than 40 due to higher costs for retrofitted rooms, hoyer lifts etc. Many hospitals use nursing acuity to support accommodation codes, but nursing acuity is not documented in the medical record, do I don't think this is the best criteria for determining accommodation codes. And if you are a verified trauma center, don't forget to look to revenue code 0208 for these patients.