Health Information Management

Refer to CMS Claims Manual when assigning revenue codes

APCs Insider, July 7, 2006

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Refer to CMS Claims Manual when assigning revenue codes

QUESTION: We struggle with how to apply the correct revenue codes for drugs given to observation patients who have undergone outpatient procedures. Could you provide some guidance?

ANSWER: Most OPPS non-reimbursable drugs are reported with revenue code 250. Report most reimbursable drugs with revenue code 636. Report radionuclides provided in the nuclear medicine department with revenue codes 343 or 344, depending on whether the drug is considered a diagnostic or therapeutic injection. Report most bedside procedures with revenue code 761 (treatment room).

If injections are provided during the observation visit, use revenue code 940. If IV therapy is provided, use revenue code 260.

For more specific guidance, refer to the HCPCS/revenue code chart found in the CMS Claims Manual, Chapter 4, Part B/OPPS, Section 20.5.

(The above Q/A appeared in the June 2006 APC Answer Letter).



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