2010 59No.2010-59 Affected Programs: BadgerCare Plus, MedicaidHospital Providers, HMOs and Other Managed Care ProgramsRequirement to Include HCPCS or CPT Codes on ForwardHealth Update lists additional revenue codes that are exempt from the requirement to indicate a Healthcare Common Procedure Coding System or Current Procedural TerminologyEffective for dates of receipt on and after July 1, 2010, and regardless of dates of service, providers are required to indicate a valid and most appropriate Healthcare Common Procedure Coding System (HCPCS) or
(CPT) procedure codes in addition to revenue codes on outpatient hospital claims for most revenue codes.Outpatient hospital claim details without a valid HCPCfor revenue codes requiring denied.
Refer to the March 2010 ForwardHealth Update(2010-22), titled ForwardHealth Now Requiring Outpatient Hospitals to Include HCPCS or CPT Codes with Most Revenue Codes on Claims, for more As indicated in Update 2010-22, certain revenue codes are In addition to the revenue codes listed in Updatethe following revenue codes do not require HCPCS or CPT procedure codes: Refer to the Attachment of this Update for a complete list of revenue codes that are exempt from the requirement.
The information in this submitted for members enrolled in Wisconsin Medicaid, the BadgerCare Plus Standard Plan, the BadgerCare Plus Benchmark Plan, the BadgerCare Plus Core Plan, and ForwardHealth Provider InformationInformation Regarding Managed Care contains fee-for-serviservices members receive on a fee-for-service basis only.For managed care policy, managed care organization.Managed care organizations are required to provide at least the same benefits as those provided under fee-for-service arrangements.ForwardHealth Update is the first source of program policy and billing information for providers.
Wisconsin Medicaid, BadgerCare Plus, SeniorCare, and Wisconsin Chronic Disease Program are administered by the Division of Health Care Access and Accountability, Wisconsin Department of Health Services (DHS).The Wisconsin Well Woman Program is administered by the Division of Public Health, Wisconsin DHS.
For questions, call Provider Services at (800) 947-9627 www.forwardhealth.wi.gov/ ForwardHealth Provider InformationATTACHMENT The following table lists the outpatient hospital revenue codes that are exempt from the requirement of submitting the corresponding Healthcare Common Procedure Coding System and Current Procedural Terminology codes on outpatient hospital claims.
The codes listed below are subject to change.Refer to the Online Handboexempt revenue codes.Revenue Codes 0250 0583 0251 0660 0252 0661 0253 0662 0258 0663 0270 0669 0271 0710 0272 0762 0276 0905 0278 0906 0370 0907 0500 0931 0509 0932 0521 0948 0522 099X 0524 100X 0525 210X 0527 310X 0528.
2002 66Department of Health and Family ServicesDecember 2002 l No.2002-66PHC 1923To:Inpatient HospitalProvidersHMOs and OtherManaged CareProgramsRevenue code changes for inpatient andoutpatient hospital claimsHospitals are required to enter revenue codesfor accommodation and ancillary services inItem 42 of the UB-92 claim form.TheAttachment of this Wisconsin Medicaid andBadgerCare Update lists the revised revenuecodes effective for dates of service on andafter February 1, 2003.
This list replaces thesimilar list in the Inpatient/Outpatient HospitalServices Handbook dated September 1999.Refer to the Wisconsin UB-92 Manual forcomplete descriptions of revenue codes.
Topurchase the Wisconsin UB-92 Manual, call theWisconsin Hospital Association at(800)362-7121 (608)274-1820 or or write tothem at:Wisconsin Hospital Association5721 Odana RdMadison WI
53719-1289Information regarding Medicaid HMOsThis Update contains Medicaid fee-for-servicepolicy and applies to providers of services torecipients on fee-for-service Medicaid only.ForMedicaid HMO or managed care policy,contact the appropriate managed careorganization.
Wisconsin Medicaid HMOs arerequired to provide at least the same benefits asthose provided under fee-for-servicearrangements.The Wisconsin Medicaid and BadgerCareUpdate is the first source of program policy andbilling information for providers.Although the Update refers to Medicaidrecipients, all information applies to BadgerCarerecipients also.Wisconsin Medicaid and BadgerCare areadministered by the Division of Health CareFinancing, Wisconsin Department of Health andFamily Services, P.O.Box 309, Madison, WI53701-0309.For questions, call Provider Services at(800) 947-9627 or (608) 221-9883 or visit our Website at Medicaid and BadgerCare Service-Specific 2002
No.2002-662Revenue codes for inpatient and outpatient hospital claimsEffective February 1, 2003The following is a complete list of Medicaid-allowable revenue codes for inpatient and outpatient hospital claims.PolicySpecific revenue codesRevenue codes that require a service-specific third digit from the UB-92Billing Manual11X, 12X, 13X, 15X, 16X, 17X, 20X, 21X, 25X, 36X, 51X,71X, 90X, 91X, 92X, 94X, 96XRevenue codes that require a CurrentProcedural Terminology laboratoryprocedure code for outpatient services30X, 31X, 923, 925Revenue codes for dental services512 (Use when providing dental services as part of anoutpatient visit.)Revenue codes for vision care services519 (Use when providing vision care services as part of anoutpatient visit.)Outpatient observation room719 (Use when recipient is under observation afterrecovering from ambulatory surgery.)Revenue codes exempt from recipientcopayment820-859, 901, 918Note: Revenue code 253 is exempt from recipientcopayment on crossover claims.Revenue code 450 is exempt from copayment for outpatientservices
.Noncovered revenue codes140-149, 180-189, 220-221, 229, 294, 374, 547-548, 550,609, 624, 637, 660-669, 670-679, 780-789, 880, 990-999Noncovered revenue codes forpsychiatric hospitals520, 529, 940, 949Noncovered revenue codes for generalhospitals billing psychiatric orsubstance abuse services520, 529, 940, 949Nonbillable revenue codesNonbillable for bill type 11X:100-101, 115, 135, 155, 240, 249, 253, 259, 279, 291-293,299, 479, 530-531, 539, 540-546, 549, 551-552, 559, 570-572, 579, 580-582, 589, 590, 599, 600-604, 650-657, 659,912-913, 960-964, 969, 971-979, 981-989Nonbillable for bill type 13X:180-239, 240, 249, 259, 279, 299, 540-546, 549, 550-552,559, 570-572, 579, 580-582, 589, 590, 599, 600-604, 650-657, 659, 912-913, 990-999.Billable, noncovered revenue code180Restricted revenue codes110-114, 116-117, 119Revenue code for medication checks510.
Hospital chargemaster guideI
1 chargemaster.It should be noted that we have tried to accommodate most payers with this guide as it relates to HCPCS or CPT codes by including all codes that normally would be chargemaster driven.
However, Medicare may not consider
of the information necessary to update the chargemaster.
fee schedules for their department before beginning the chargemaster maintenance process.
Ingenix, Inc.s and Ingenix, Inc.s HCPCS Level II code books will provide more detailed information on revenue code and All CPT-order.
A suggested abbreviated code description is printed next to each code.
This shortened description may t more for the denitions of the OPSI.
The information in these tables may be used to verify the appropriate revenue code and to evaluate the charge.
It should be emphasized that hospitals should develop charge codes for all billable services that they provide to patients, even if the services are not paid or are packaged by Medicare.
The charges are included in the Periodically, Medicare revises the OPPS, fee schedules, revenue codes, and correct coding edits.
These revisions are important when billing services on the UB-92 or its electronic equivalent.
They provide a reference guide to determine the alerts pertain to all providers; however, it is important for providers to keep abreast of the issues currently under
5 plies, and drugs that are billed on the UB-92 or its electronic equivalent.
(See UB-92 claim form in appendix III.)
Each item listed in the chargemaster le has several corresponding data items as described below.
Most hospital chargemas-The layout of individual facility chargemasters varies from hospital to hospital.
However, most facilities include a core group of data elements that are required for a viable chargemaster.
The data are as outlined below.Example:
Department 496, radiology, may have a chargemaster le layout as described in the table below.for a specic procedure or service represented on the chargemaster.
In some cases, the department number (described above) may be the rst several digits of the charge description number.
In this case, there may not be a separate An example of this type of le layout would be as shown below.This is the name of the procedure or service.
The description is hospital-specic but should be listed in a Dept.#496Chargemaster #49683105Use revenue code 0636 for drugs requiring detailed coding.
The intent of the revenue code is to report charges for This eld contains the HCPCS or CPT code applicable to the service billed on that line or, in the case of inpatient claims, the room rate amount.
It is required for outpatient billing under OPPS.
Section 9343(g) of the Omnibus Budget Recon-Although the edit indicates a HCPCS code is required, the presence of a HCPCS code does not guarantee payment.
Pay-ment is determined by the outpatient payment status indicator (OPSI) assigned to each APC grouping.
See addendum Revenue CodeDescription030XLaboratory 031XLaboratory (pathological)032XRadiology (diagnostic)033XRadiology (therapeutic)034XNuclear medicine035XCT scan036XOperating room038XBlood0390Blood and blood component adminstration, processing and storage040XOther imaging services041XRespiratory services042XPhysical therapy043XOccupational therapy044XSpeech language pathology045XEmergency room046XPulmonary function 33 Historically, hospital chargemaster maintenance has been assigned to an individual, usually in the nance or business ofce area.
The chargemaster designee has been responsible for reviewing the chargemaster annually and for making chargemaster designee called upon clinical department managers for assistance in updating the chargemaster.
But the chargemaster.
During the last several years, chargemaster maintenance procedures have changed and now include review and revision by the clinical department managers.
Even though this has been an improvement to the process, changes and how they impact the chargemaster.this committee in maintaining and updating the chargemaster.
The committee should meet on a quarterly basis and )A standardized charge description master (CDM) and a team approach for review and change can benet the hospital in the following ways:
a standardized CDM improves reimbursement, ensures that prices are uniformly applied, identies lost charges, and reduces problems that may surface during an audit.
Some common causes for lost revenue include items used, but not included in the CDM, supplies used but not charged, identical items from two different departments with different prices, and illogical pricing scenarios.
a standardized CDM can ultimately lead to reduced resource utilization and costs.
By bringing department leaders together to discuss common practices, terminology, and reporting, reports may be produced standardizing improves billing accuracy, training, communications, and implementation of
a multifacility organization, in particular, benets by reducing new information system even though chargemaster revisions were made on paper, hospitals found chargemaster sit on an individuals desk without being implemented.CPT are considered to be included in the primary APC payment.
However, it is important to bill them as FL 6 Statement Covers PeriodFL 4 Type of 131FL 24-30 Condition CodesRev.CodeotalCharges0320FL 67 Prin.Diagnosis Code 53 Although the OCE has been used by scal intermediaries (FIs) for years to edit outpatient surgery and ambulatory sur-paid correctly.
Many of the edits in the OCE under the outpatient prospective payment system (OPPS) are new to hos-Samoa, Guam, and Saipan; childrens hospitals or cancer centers.
In addition, claims from Virgin Island hospitals and informa