Corporate Compliance

Revenue codes

Compliance Monitor, July 13, 2007

Q: We would like to know if clinics that perform skin grafting procedures using materials like Apligraf (R) or Oasis (R) in the clinic setting (versus the operating room) bill these procedures using revenue code 0361 or 0510, and how different insurers are responding to these revenue codes.

A: You can use several revenue code options to bill hospital outpatient department E/M visit and procedure codes, which include services performed by certified wound care nurses, non-physician practitioners such as nurse practitioners and physician assistants, and physicians. The two revenue codes listed above (0361, 0510) are valid options, as is revenue code 0761.

As many hospitals know, commercial and managed care insurances often have problems correctly processing claims with revenue code 0510; therefore, revenue code 0361 or 0761 are valid options. Hospitals often set up these two revenue codes in their billing system to pull CPT codes from the chargemaster (i.e., hard-coded). Wound care clinics often use hard-coded, chargemaster-driven visit and procedure codes as opposed to soft coding by health information management coders.

Note: This Q&A came from HCPro's APCs Weekly Monitor.

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