Ask the Board

In this exclusive column, TWC offers readers the chance to ask industry-related questions to our expert editorial board members. This month, we received several questions pertaining to the appropriate selection of revenue code(s) for use in hospital-based outpatient wound care (HOPD) departments. Q: Which revenue code should be used on the HOPD Charge Description Master (CDM)? A: BY KATHLEEN D. SCHAUM, MS   Confusion apparently reigns in the “revenue code” world. For example, one reader writes: “I am the medical director of a large university HOPD. The CDM director and I are having a disagreement. I believe the HOPD should use revenue code 510. The CDM director believes the HOPD should use revenue code 761. Can you please pick the “winner” of this debate?   Sorry to say, but there is no “winner.” Both the medical director and the CDM director are 50% correct and 50% incorrect. Let’s discuss. As you already know, four-digit revenue codes are related to the various ancillary services that are billed by an HOPD. Different revenue codes must be linked to specific Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology® (CPT) codes on your CDM. Some typical Medicare linkages are:     • 0510 or 519 Clinic is typically linked to CPT codes 99201-99215. Check with the Medicare Administrative Contractor (MAC) who processes your Medicare claims.     • 0636 Drugs Requiring Detailed Coding is typically linked to separately payable cellular and/or tissue-based products for wounds (outdated term “skin substitutes”) HCPCS codes Q4101 – Q4133.     • 0761 Treatment Room is typically linked to surgical procedures such as 11042-11047.   Although this seems simple enough, there is one catch: Not all payers require the same revenue code linkages as does Medicare. In those cases, you must build different revenue codes into your CDM for different payers. For example, some MACs accept revenue code 0510 Clinic, but many other payers do not cover services billed under 510. You should review your major payer contracts and their billing manuals to determine the appropriate revenue codes to link to the HCPCS and CPT codes that represent your HOPD services, procedures, and products. Then, build the payer-specific revenue codes into your CDM for each payer. For an in-depth discussion of HOPD CDMs, attend an all-day 2013 Wound Clinic Business seminar: www.woundclinicbusiness.com. Better yet, bring your entire revenue cycle team and your medical staff to the seminar: It is a great opportunity to learn together! Kathleen D. Schaum can be reached for questions and consultations by calling 561-964-2470 or at kathleendschaum@bellsouth.net. For a full disclaimer related to the information in this column, please refer to Business Briefs on page 6.