A revenue code in medical billing is a 3-4 digit number that identifies specific services provided in a healthcare facility. Suppose a patient comes for an elbow surgery and gets other treatments like therapy and medications.
Every service has a unique code which is later mentioned in the UB-04 claim form to help payers identify the main category of charge and process the claims. This blog will explore important details such as the revenue codes structure, its importance and best practices when assigning revenue codes.
Understanding Revenue Codes
A revenue coding system was developed for the Medicare system. Over time, its implementation was observed across all healthcare sectors to simplify medical billing operations. Revenue codes serve as a standard identifier and play a great role in streamlining the claim submission process by helping doctors simplify the medical bills.
The National Uniform Billing Committee issues and maintains these codes to ensure every medical expert across the USA uses these codes against the services rendered.
Revenue Codes Structure
Revenue codes in medical billing have a simple structure, as the first number of codes indicates the type of service a patient receives. Below is an example
Room codes (010-219) cover the rooms where patients are admitted
- Regular rooms
- Emergency rooms
- Surgery recovery unit
- ICU (Intensive Care Unit)
Service codes ( 220-999) reflect treatment and tests
- Lab Tests
- X-rays
- Scans
- Prescriptions
- Operating rooms
<h4>Revenue Code Examples</h4>
Earlier, revenue codes in medical billing only had 3-digits, but now you might find 4 numbers in a code with a 0 in start. Therefore, the insurance payers easily understand these codes after seeing the first digit. However, if the last digit of the code is also 0, it means the services provided to patients are not specific but general.Here are the examples:
1) Intensive Care Unit Codes
Revenue codes that reflect procedures performed in the ICU are known as Intensive Care Unit codes or 20x.
- General – 200
- Surgical – 201
- Medical – 202
- Pediatric – 203
- Psychiatric – 204
- Intermediate ICU – 206
- Burn Care – 207
- Trauma – 208
- Other – 209
2) Physical Therapy
Codes that indicate physical therapy come under the head of physical therapy code or 42x
- General – 420
- Visit Charge – 421
- Hourly Charge – 422
- Group Rate – 423
- Evaluation or Reevaluation – 424
- Other Physical Therapy – 429
3) Emergency Room
Emergency room codes are very few in the number compared to others. They come under the emergency room code or 45x
- General – 450
- EMTALA Emergency Medical Screening Services – 451
- ER Beyond EMTALA Screening – 452
- Urgent Care – 456
- Other Emergency Room – 459
Importance of Revenue Codes in Medical Billing?
Revenue codes in medical billing lay solid foundation of an efficient medical billing process. Without proper coding, the providers might struggle to receive accurate and timely payments.
Efficient Claim Processing
When a healthcare provider bills any service, he expects quick revenue from payers. While they verify codes against every service rendered before reimbursement. In case of unassignment or wrong assignment of the codes, payers reject the claims and providers lose their hard-earned revenue.
Indicate the location of services
We all know that ICT and CPT codes are used for the diagnosis and patient treatment. Similarly, the revenue codes indicate the exact location where services were delivered for instance in Operation theater, emergency room or general hospital rooms. Therefore, every location will have a different code to help payers identify the services location and reimburse the payments.
Combining Similar Services
Revenue codes in medical billing help hospitals and physicians to club similar services, reduce administrative workload and get quick payments. Combining all the services helps providers make a bundle of various procedures.
Compliance
NUBC (National uniform billing committee) founded by American Hospital Association, is responsible for maintaining and updating the revenue codes, ensuring healthcare organizations are following a dedicated process.
The committee is also connected with regulatory bodies like Medicaid, Medicare, etc. Therefore, using correct revenue codes automatically keeps the healthcare organizations compliant with private and government funded programs.
Medical billing revenue codes have a very easy structure, however, providers should assign them accurately to avoid the claim denials and revenue leakage. In addition, we are offering some tips to ensure you don’t end up losing the payments.
How to Use Revenue Codes in Medical Billing
- Every healthcare expert pays attention when assigning the revenue codes against the services provided. However, if you are confused between the codes, visit the NUBC website to check the update codes. Providers can also coordinate with payers to get the new codes list.
- Make sure to use a revenue code along with a CPT code. This will explain to the payers what procedure was done. Avoid using incomplete revenue code if you want to maximize the practice revenue.
- Use a separate line to assign a combination of codes when filling the claim form. It ensures that services provided to patients are not combined together. Assigning a single code against all services can reject the claim.
- Follow all the guidelines by payers when assigning the revenue codes. It will help providers get timely reimbursements.
- Cross-verify the service nature and destination before writing the codes to ensure every code is accurate.This practice will save your time, streamline the billing and boost revenue.
Use of Revenue Codes in Different Healthcare Facilities
Use of revenue codes in medical billing relies heavily on the type of healthcare facility where services are rendered.
For instance, large healthcare centers assign revenue code for everything from a patient visit, emergency room, and surgeries. On the other hand, small clinics focus on the outpatients and assign codes against simple lab tests and patient visits.
Nursing homes utilize a combination of room and treatment codes. Although, their patients stay for days, weeks and months leading to daily assignment of the codes .
Final Notes
Revenue codes in medical billing are very simple in structure and enable providers to use the right codes and receive timely payments. However, small mistakes in coding results in a delayed claim causing revenue loss. Therefore, providers must gain the understanding about revenue codes, and ways to accurately assign them.
This blog also covers the best practices to assign the revenue codes. You can also coordinate with Paymedics expert coding team to streamline your billing process and maximize revenue.
Frequently Asked Questions
What is a revenue code in medical billing?
A revenue code is a 4-digit number that highlights the nature and location of the healthcare services given to the patient.
What is the difference between a revenue code and a CPT code?
A revenue code indicates the type and location of services while CPT code describes the actual procedure/services provided by the healthcare expert.
What is the revenue code 100?
The revenue code 100 indicates Room and board – all inclusive plus ancillary.
What is the revenue code 0471?
The code 0471 reflects moderate healthcare services such as prescription management and various diagnoses.
What is NUBC?
The NUBC (National Uniform Business Committee) founded by American Hospital Association, maintains and updates the revenue code to ensure a smooth billing process.
