Critical Case For Billing & Coding

Critical Case For Billing & Coding

 Complete the Critical Case for Billing & Coding simulation within the Navigate platform.

241.25 450 99218
3160002 EMERG DEPT OBSERVATION 3–6HRS 13160 406.00 450 99218
3160003 EMERG DEPT OBSERVATION 6–12HRS 13160 492.00 450 99219
3160004 EMERG DEPT OBSERV. OVER 12 HRS 13160 592.75 450 99220
4465350 OUTPAT VISIT LEVEL 1 (NEW) 14465 78.50 510 99201
4465351 OUTPAT VISIT LEVEL 2 (NEW) 14465 92.25 510 99202
4465352 OUTPAT VISIT LEVEL 3 (NEW) 14465 112.50 510 99203
4465353 OUTPAT VISIT LEVEL 4 (NEW) 14465 159.75 510 99204
4465354 OUTPAT VISIT LEVEL 5 (NEW) 14465 $209.00 510 99205

The fifth column is the revenue code. Revenue codes are a required field in any hospital claim that is submitted on a UB-04. The current categories used have been mandated by CMS, and the current list is presented in  Table 2–9 . The last column included in many charge masters is the field for the HCPCS code. In our sample charge master not all entries have an HCPCS code. For example, the first two entries that relate to room and board charges do not have an HCPCS code. Also notice that surgery and anesthesia do not have an HCPCS code. Most hospitals bill for a great majority of their surgeries on a time/level basis. Someone from Health Information Management assigns a CPT code or an ICD-9 procedure code to the procedure at a later point in time before billing. Where an HCPCS code is present in the charge master, less time is required in coding claims at the back end, but care needs to be taken that appropriate charge codes are used at charge entry.

Table 2-9 Revenue Code Categories

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