What are Revenue Codes in Medical Billing?

In 2021, around 16% of all medical claims submitted received a denial code. That percentage may not sound like a large amount, but let’s look at it from a different perspective. That percentage ended up equaling about 48 million denied claims! This goes without saying that millions of dollars in revenue sat untouched with those denied claims, affecting tons of practices.

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But how do you avoid a situation like that happening to you and your practice? Understanding the healthcare billing process and the specific standards that are in place is a great place to start. With ever changing rules and guidelines, the idea of staying above everything is a tall order to fill.

When it comes to medical coding, one of the most important things to understand is… well, the different codes. There are different kinds of universal codes that apply to all insurance carriers in the United States, but including all of them in this video would take far too long. For today, let’s look at revenue codes and how important they are in the medical billing field.

First developed for the Medicare system, revenue codes were soon adopted as a standard for hospital billing as well as in other healthcare settings. Revenue codes are a standardized system that identifies any accommodations and specific services provided to patients in a healthcare setting. These services may include room and board, imaging services, medications, and more.

These codes not only tell the insurance company what kind of service the patient receives, but as well as where in the hospital they received it.
The way these codes are set up is relatively simple, but there are hundreds of them. Revenue codes include three or four digits which hold information concerning a patients' medical care and other services. These codes need to match with procedure codes for insurers to accept the claim.

Without revenue codes you will be hard pressed to get an insurance company to accept your submitted claim. Therefore, you won’t be getting paid for those services.

The National Uniform Billing Committee (NUBC) maintains revenue codes, founded in 1975 by the American Hospital Association. On top of this responsibility, the organization serves as the authority over other forms and codes used in American medical claims.

Like I said before, revenue codes are important to distinguish exactly where a procedure takes place, the kind of equipment used and if the patient takes the equipment home for use. What I mean to say is that the difference between receiving treatment in the emergency room, operating room or another department will all result in different costs!

In these cases the procedure code stays the same but the revenue code varies.

Here is an example to better understand this complex subject. A medical professional can perform a blood transfusion in the emergency room or a treatment room. If the patient receives the transfusion in the emergency room, then the revenue code used is 0450. If performed in a treatment room, the code is 0761.

Due to the many different variables in a hospital setting, revenue codes have a huge role to play when it comes to having medical claims accepted by payers and receiving the proper reimbursement.

Revenue codes are a crucial aspect of any medical coder’s day-to-day functions. They are here to make the complex process of medical coding and billing easier for you. Every coding team should receive proper education and training on these codes as well as make sure to keep detailed documentation on current procedures.

Making sure your coding is accurate helps your facility receive the right amount of reimbursement for services rendered and helps you better streamline your revenue cycle.

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