Health Information Management

Tip of the Week: Use revenue code 450 with Type B visits

APCs Insider, May 4, 2007

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The major problem with using clinic CPT E/M codes to bill the new Type B ED visits to non-Medicare payers is claims submission: If you use revenue code 51x (clinic) to bill Type B visits in conjunction with ED visit codes 99281-99285, the claim may not process due to discrepancy between CPT and revenue code. Additionally, many private payers do not reimburse for clinic visits.

Therefore, you must use revenue code 450 (emergency room). "No other payer has 'clinic codes' for ED visits," says William Malm, ND, RN, president of Health Revenue Integrity Services, Inc., in Cleveland. "It does make sense to bill them as an ED visit at a lower cost to charge, which is what one private payer recommended."

Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance for HCPro, Inc., in Marblehead, MA, agrees. "As far as I'm concerned, the special codes for 'fast tracks' are a Medicare concept only, and if the care is provided within your ED, you would use an ED code because your ED is open 24 hours," she says.

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