Question: Do all revenue codes require a HCPCS code? For example, if we report revenue codes for the emergency department or drugs, do we need to accompany them with CPT codes?
Alabama Subscriber
Answer: No, not all--while most revenue codes do require HCPCS, several do not. The requirements also vary based on the type of bill (TOB) and, occasionally, the fiscal intermediary or other payer involved.
In your example, under the outpatient prospective payment system (OPPS), revenue codes in the 045x range (Emergency room) require HCPCS codes, but those in the 025x range (Pharmacy) do not. In general, most drugs (such as topical ointments, oral analgesics and antibiotics, transdermal patches, etc.) do not have specific HCPCS codes and thus are “packaged” under OPPS. A revenue code category alone is sufficient for reporting.
You should report those pharmaceuticals and biologicals payable under OPPS under revenue code 0636 (Drugs requiring detailed coding), which, as its name implies, does require HCPCS code assignment.
