Q&A: Applying revenue codes across payers

November 11, 2019
Medicare Web

Q: Do we need to use the same revenue code for the same service across all payers, even non-Medicare payers?

A: It cannot be emphasized enough that the requirements in the NUBC Manual apply to all providers, payers, and other HIPAA-covered entities, such as clearinghouses. Certain revenue codes, for example, must be used when billing services to all payers; it is often not an option to use a different revenue code. For example, now that there is a new revenue code for cell therapy products such as chimeric antigen t-cell products (revenue code 0891), then that revenue code should be used for all payers, inpatient, and outpatient claims. It also cannot be emphasized enough that each value in its field as reported on the claim works in concert with all other parts of the claim to communicate the story of the patient care and the costs of that care. All values in all fields have the weight of law behind them and must be periodically validated to ensure that inaccurate values are not reported. It is important to apply the same degree of verification to fields that are informational as those fields that impact the payment amount made on the claim. Often, efforts are expended only on those values that impact payment, while other values on the claim may be inaccurate and therefore do not accurately communicate circumstances. This can contribute to a claim that is false or fraudulent.

For more information, see The Chargemaster Essentials Toolkit, Second Edition.