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Understanding Medical Billing and Revenue Codes

Understanding Medical Billing and Revenue Codes

Published by: Melissa Clark, CCS-P on July 31, 2006

Not all medical billing is generated from physician’s services. Sometimes services are rendered to patients and the medical billing created from those procedures need to be submitted to the various insurance carriers, but they also need three things: a price, a procedure code, and a revenue code.

Revenue codes indicate to the type of service that you are billing for; revenue codes are 3-digit codes, and those revenue codes must match up with specific procedure codes to designate what services were rendered.

For instance, if you are using a 360 revenue code, you’re stating that the services rendered were performed in the operating room, and therefore, the procedure codes that match up with it need to be between 10000 and 69999, which are the surgical procedure codes range. Radiology and all its different incarnations are between 320 and 350, with ultrasound in the 400 range; labs are 300 – 319, and so forth.

Revenue codes go from 000 through 999, though many codes aren’t applicable across the board, and not all of the numbers are generally used. For instance, the lower numbers denote hospital inpatient rooms, and the highest numbers denote patient convenience items while they’re inpatients.

Some procedure codes can match up with multiple revenue codes, depending on where the service might be performed. For example, endoscopic surgical procedures can go against 360 for operating room, 450 for emergency room, 490 for ambulatory surgery center, and 750 for endoscopy, because it depends on where the service has taken place. Then, in another instance, no matter where lab services are performed, their codes are always between that 300 – 319 range.

Published by: on July 31, 2006

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