Revenue codes are four-digit numbers used on hospital bills to show insurers what type of service or item a patient received. They are essential for hospital billing and are used alongside procedure codes. Revenue codes help insurers understand the need for the service and decide how much to pay.
These codes are updated regularly by the National Uniform Billing Committee (NUBC). The first digit of the code represents the general category of the service (like room and board or laboratory tests), while the last three digits provide more specific details.
The Importance of Revenue Codes
Revenue codes are important for several reasons:
- Detailed Information: They provide extra details that procedure codes alone might not cover. For instance, a procedure code might show that an X-ray was done, but a revenue code specifies if it was done in the emergency room or another location.
- Accuracy Check: They help insurers verify the accuracy of charges. If an X-ray is billed under the wrong revenue code, it might signal a mistake or potential fraud.
- Payment Rates: They help determine how much insurers will pay for different services or items. For example, services in an intensive care unit might be paid at a higher rate than those in a regular ward.
How to Use Revenue Codes Correctly
Here are some tips for using revenue codes properly:
- Match Codes: Use the correct revenue code that matches the service or item provided. Check the current list of codes on the NUBC website or your payer’s guidelines.
- Pair Codes: Always pair a revenue code with a procedure code that describes what was done. Don’t use a revenue code alone or with the wrong procedure code.
- Separate Lines: List each revenue and procedure code combination on separate lines of your bill.
- Use Modifiers: Add modifiers if needed to give extra details about the service.
- Follow Guidelines: Check payer requirements as they may have specific rules for using certain revenue codes.
Room & Board Revenue Codes:
- 012X: Room & Board – Semi-private Two Bed
- 013X: Semi-Private – Three and Four Beds
- 014X: Private (Deluxe)
- 015X: Room & Board Ward
- 016X: Other Room & Board
Ancillary Services Revenue Codes:
- 025X: Pharmacy
- 027X: Medical/Surgical Supplies
- 029X: Durable Medical Equipment (DME) (Other Than Renal)
Laboratory and Radiology Services Revenue Codes:
- 030X: Laboratory
- 031X: Laboratory Pathological
- 032X: Radiology – Diagnostic
- 033X: Radiology – Therapeutic
- 034X: Nuclear Medicine
- 035X: CT Scan
Specialty Services Revenue Codes:
- 020X: Intensive Care
- 021X: Coronary Care
- 036X: Operating Room Services
- 037X: Anesthesia