What is the revenue code in medical billing?

What is the revenue code in medical billing?

As per NUBC (National Uniform Billing Committee), the revenue code indicates specific  accommodations, ancillary services, billing calculations, and arrangements relevant to the claim. It  is a three or four-digit code carrying information-specific procedures to designate the services  performed by the provider. 

Revenue codes are universal codes that make the process smoother for a clean claim. The revenue  codes were made mandatory in hospital billing to convey to the insurers when and where the patient  received the treatment or what type of equipment to withhold the medical necessity. 

The insurers can deny the submitted claim if this goes missing, and the provider has to forget about  the reimbursement for the rendered services. Revenue codes also reveal the procedure in the  operating room, emergency room, or another department. 

There are three sets of universal codes that hospitals run for different goods and services to reveal to  the insurers that the patient existed while receiving the treatment. 

  • ICD-10 for diagnosis 
  • CPT for procedures 
  • HCPCS for medical goods and services 

Such information is crucial as most of the procedures get conducted in different areas of a hospital.  For instance, stitches get undertaken in the maternity ward, emergency room, or other designated  premises. This information decides the price for the procedure. 

If a revenue code for medical billing is attached to a supply code, it indicates the location of the  equipment was in the hospital or taken home by the patient. Therefore, revenue codes support the  revenue cycle of the hospital. 

Procedure codes complement a revenue code and indicate what the provider did during the  encounter to be accepted by the insurer. It makes up 81 fields on the UB-04 form, where the revenue  codes describe the field 42-49 as standard for hospitals. 

Earlier revenue codes were three digits, but now, they are four digits due to the need for an  additional code. The first digit in the revenue code represents zero. If a revenue code ends with zero,  the service is unspecified. When a revenue code ends with a nine, this indicates others in any given  category. 

If a claim makes its way to the insurer without a revenue code, it gets rejected. The most common  revenue codes help insurance companies with procedures, supplies used, types of treatments, and  equipment to determine the reimbursement amount. 

Code 250- Pharmacy services 

Code 270- Medical or surgical supply 

Code 272- Sterile supply 

Code 274- Prosthetic or orthotic equipment 

Code 276- Intraocular Lens implants 

Code 278- Other implants 

Code 279- Supplies

Code 320- X-rays 

Code 370- General anesthesia  

Code 379- Other anesthesia 

Code 490- ASC (Ambulatory surgical center) procedures 

Code 710- Recovery room charges 

The above list of revenue codes out of the hundreds makes the reimbursement hassle-free and  prevents any confusion or rejection of claims. Medical billers and coders specialists play an  indispensable role in assigning the codes to bill forms, as any discrepancy can cause a penalty and is  considered fraudulent on the part of the hospital. 

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