What Are Revenue Codes in Healthcare? A Complete Guide

Are you struggling to understand your medical bill?

Bills from hospital visits and treatments can be very complex. Every test, procedure, and treatment need to be clearly marked on the bill in a way that can be easily understood. This is why the healthcare industry uses standardized codes. But to the uninitiated, these codes can be as hard to understand as medical jargon. Unless you know what the codes mean, you won’t be any closer to understanding what you are being billed for.

We are here to help. Read on for our guide on healthcare revenue codes to help you understand what you see on your medical bill.

What Are Revenue Codes?

Revenue codes are a set of standardized 4 digit numbers used in medical billing. Although codes are 4 digits, you may see codes with only three digits. In this case, a leading 0 is implied. For example, revenue code 761 is the same as revenue code 0761.

Revenue codes are set by the National Uniform Billing Committee (NUBC). This means every healthcare provider gives standardized information when billing.

The purpose of revenue codes is to provide extra information about a procedure or service, such as where a patient received care. Revenue codes are on every billing line and are always linked with other codes used by healthcare professionals:

  1. ICD, diagnostic codes for each patient
  2. CPT, procedure codes for each service given
  3. HCPCS, codes for products, supplies and services administered

This information is essential for medical insurers and other third-party payers. The reason revenue codes are so important is because hospitals have many different areas and wards able to provide the same service. As there can be a difference in price for the same procedure in different areas revenue codes help track this. Your insurer needs to know whether they happened in the emergency room, observation room or in a ward. When linked to a product or piece of equipment, they show where it was to be used/taken.

Insurers will reject any claims without a revenue code.

ICD Codes

International Classification of Diseases (ICD) codes represent one of 70,000 plus symptoms and diseases. As such you will likely find the same code on any bills you receive for ongoing issues.

ICD codes are an international standard run by the World Health Organization (WHO). You will find them in use in most countries around the world. The version currently in use is ICD-10, the tenth revision of the system.

ICD-10 codes are broken down into chapters and subchapters. These group conditions or characteristics and are given a letter. Here are some examples:

  • E for represent an endocrine, nutritional, or metabolic issues
  • I for problems with the circulatory system
  • P for perinatal issues
  • K for digestive issues

Although some code letters match up the first letter of the issue, this is not standard practice.

This is followed by two numbers, a period, and another number to denote the specific condition. This gives each diagnosis a code in the following format: X00.0.

As well as your medical bills, the ICD code will also be on your paperwork, charts, and hospital records. The hospital will also use them to track disease statistics.

CPT Codes

Current Procedural Terminology (CPT codes) represent the services given to a patient. This covers diagnostic, medical, and surgical services.

Standardized CPT codes are managed by the American Medical Association (AMA). The complex nature of medical treatment means that there are thousands of codes in use. As new procedures come into use codes are revised and new ones created.

All CPT codes are organized into three main categories:

  • Category I: Procedures, services, devices, and drugs
  • Category II: performance measurement
  • Category III: emerging technology, services, and procedures

Each code consists of 5 characters, either 5 numbers or 4 numbers and 1 letter. Codes are highly specific and are designed to have as little overlap as possible.

On your medical bill, every procedure that you have received is shown on the bill and assigned its relevant CPT code. This is then used by the insurer to work out how much they pay the medical provider of the service.

When an insurer receives your claim they will look at the ICD code and the CPT and check if the procedure is relevant for your issue. For example, they will likely query any stitches given for a stomach upset. If they don’t make sense, they will reject the claim.

HCPCS Codes

Healthcare Common Procedure Coding System (HCPCS codes), like CPT codes, represent services given to patients. They differ in that they are created specifically for Medicare and Medicaid.

The codes are managed by the Centres for Medicare and Medicaid (CMS) specifically to show what procedures Medicare and Medicaid recipients are eligible for.

HCPCS codes are split into three levels:

  • Level 1: Procedures and services
  • Level 2: Non-physician services (such as ambulance rides and provided wheelchairs)
  • Level 3: Local codes set by the state Medicaid body

As Level 1 codes serve the same purpose as CPT codes, the CMS decided to use the same CPT codes themselves. This greatly simplifies the system, although technically when used for billing Medicare the CPT codes will be HCPCS codes.

Level 2 codes fill a gap in CPT by giving information about non-service items like the specific product provided. This extends to drugs given, and are highly specific. The type of drug, dosage, and how the drug was administered are all covered.

HCPCS are treated in the same way as CPT codes by third-party payers. Like CPT they will be compared against the revenue code and ICD when analyzing a claim.

Common Revenue Codes

Healthcare is a wide area with hundreds of revenue codes in use. Healthcare administrators need to put a lot of work into learning all the codes and their uses. But most people will only ever see the most common ones. Here are some of the most common codes you are likely to come across.

Revenue Code 761

Revenue Code 076X covers specialty services.

The most seen code in this group is 0761, which covers a treatment room. In fact, it is probably the most common revenue code you will see. This covers most general visits to a doctor unless you need more specific diagnostic equipment.

Anther common revenue code in the group is 0762, which covers observation hours.

Revenue Code 0250

Revenue Code 025X covers Pharmacy services. These include drugs dispensed by a licensed pharmacist.

Code 0250 is used for “General” pharmaceutical services, as opposed to generic drugs (251) or home drugs (253). Some hospitals use this to report general drugs not covered by the more specific categories, or for appointments with pharmacists.

You may also see pharmacy services under code 063X. This is an extension of the original pharmacy codes and includes services like 0631 (Single source drug) and 0637 (Self-administrable drugs).

Revenue Code 0170

Revenue code 017X covers nursery services. This covers a baby’s stay in hospital.

Code 0170 is used for nursery charges that are in good health, likely due to the mother receiving postpartum care. Other codes in the group are used to specify the needs of babies, if they are premature, or otherwise unwell, etc.

Revenue Code 301

Revenue code 030X covers laboratory services. Most samples taken for testing will end up with this revenue code.

The most common revenue code in this group is 0301, chemistry. Most laboratory tests will be covered by this code, although a notable exception is 0307, urology for urine samples.

Revenue Code 915

Codes 090X and 091X cover behavioral health treatments and services. You may also this category referred to as psychiatric and psychological services.

Hospitals offer several different therapies that fall under these categories, including play therapy (0903), chemical dependency (0906), and rehabilitation (0911). The most common therapy that you will see is revenue code 915, which covers group therapy.

Revenue Code 361

Revenue code 036X covers operating room services. If you are operated on you will see a line on your bill with this code group.

The most commonly see code is 361, minor surgery. Most surgeries are covered by this code. Organ transplants also have their own codes, 0367 for kidney transplants and 0362 for all others.

Revenue Code 370

Revenue code 037X covers anesthesia.

The most common anesthesia code you are likely to see is revenue code 370, general anesthesia. This will be used for almost all situations where traditional anesthesia is used, including both local and general anesthetics.

Understanding Revenue Codes

As you can see, there is a lot of complexity when it comes to healthcare billing. Not only does each line on your medical bill have a revenue code to say where a service was administered, it also has a CPT or HCPCS code to define the service, and an ICD code to cover what it was used to treat.

Although there are a huge number of revenue codes, most of us will mostly only see the most common ones, so learning these will go a long way to helping you understand your bill.

If you have any questions about medical billing, don’t hesitate to contact us. At Amazing Healthcare Consultants, our experienced medical professionals are here to assist with your every question to help you navigate the Healthcare Maze.

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