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