Revenue Code Vs Drg

Drg rates and or per diems as stated in their contract.

Revenue code vs drg. There are 81 fields on the ub 04 and the revenue codes are located by field 42 49 fl42 49. The first scenario is the situation for which the outlier clause in a drg contract was intended. We therefore see the tremendous role that revenue codes have in the revenue cycle of a hospital. Florida blue can only accept claims with up to 12 diagnosis codes and up to 6 procedure codes.

Drg focused ob newborn revenue code chart this chart is designed to match revenue codes with instructions for how to bill ob and newborn related revenue codes on the ub 04 claim form. The claim is submitted for the newborn s entire nicu admission with a single revenue code level that reflects a higher resource use intensity than is documented in the medical record for the entire duration of care. Ensuring organ acquisition charges are not included in the inpat ient prospective payment system ipps payment calculation. Rather than paying the hospital for each specific service that was provided medicare or a private insurer will pay the hospital a predetermined amount based on the patient s diagnostic related group.

All other information remains the same. Diagnosis codes impacting the drg assignment should be in the first through 12 diagnosis code position. Using the chart providers must apply policy stated on the previous pages of this section in addition to the policy highlighted in the charts. Residential treatment center chemical dependency.

Ambulatory payment classifications apcs are a classification system for outpatient services. A valid procedure code must be accompanied by a revenue code for it to be accepted by the insurance provider. Cardiac cath lab. 0913 and or 0905.

Inpatient rc 0116 and or 0126. A drg or diagnostic related group is how medicare and some health insurance companies categorize hospitalization costs and determine how much to pay for a patient s hospital stay. The higher the relative weight the more resources are required to treat a patient with that drg. Drg coding advisor do you know the difference between apcs and drgs.

This is why very serious medical situations such as organ transplants have the highest drg weight. Revenue code description cpt hcpcs code 0300 0309 laboratory clinical diagnostic code for lab procedure performed 0310 0319 laboratory pathology code for pathology procedure performed 0320 0329 radiology. Report only the icd diagnoses codes corresponding to conditions that affect the treatment received and or length of stay. Both apcs and drgs cover only the hospital fees and not the professional fees associated with a hospital outpatient visit or inpatient stay.