Wiki Inpatient billing of CPT codes

[racker@motivhealth.com]

Hello kinda new to all this so sorry if this is a general or well known answer. For inpatient billing are CPT codes required on Itemized Bills to payor? Also are CPT codes ever required on Itemized bill for drugs or Rev codes 360 to payor?

 

[sls314]

Hello kinda new to all this so sorry if this is a general or well known answer. For inpatient billing are CPT codes required on Itemized Bills to payor? Also are CPT codes ever required on Itemized bill for drugs or Rev codes 360 to payor?

Do you mean the UB-04 claim form or the actual itemized statement? It sounds like you might be talking about the facility claim form, so that's how I'm answering my question.

For an inpatient facility claim, the ICD-10-PCS codes are used to show what services provided. You wouldn't typically see a CPT or HCPC associated with most revenue codes on an inpatient facility claim.

Outpatient facility claims will have a CPT listed with Revenue Code 360 to show what surgery was performed. There can be other CPT and HCPC codes associated with different revenue codes as well. (For example, you'd list the CPT code for a CT, MRI, and labs.)

 

[thomas7331]

Agree with Susan here but would add that CPT codes on inpatient facility claims are actually not allowed on electronic claims submissions as they're not part of the HIPAA codes set for that type of claim - if you include a CPT code on an inpatient facility claim it will likely cause a rejection (or it will be stripped off the claim by the clearinghouse). A payer should not be requiring this; however, they may request additional records or other information to investigate what services were rendered during the inpatient stay.

 

[racker@motivhealth.com]

Yes the questions listed above would be the facility claim form. Thank you so much for responding, your answers were extremely helpful. Hope you don't mind my additional question. Trying to understand requirements from the facility claim form to an actual itemized statement, can payors ask for CPT/HCPCS codes on inpatient services when requesting an Itemized statement? Or like the facility claim they can not, if so why?

 

[thomas7331]

Yes the questions listed above would be the facility claim form. Thank you so much for responding, your answers were extremely helpful. Hope you don't mind my additional question. Trying to understand requirements from the facility claim form to an actual itemized statement, can payors ask for CPT/HCPCS codes on inpatient services when requesting an Itemized statement? Or like the facility claim they can not, if so why?

I've never heard of a payer asking for CPT/HCPCS codes on an itemized statement, but I don't know of any rule that says they can't ask for it. However, I think it's an unreasonable request and I wouldn't do it for them. An itemized statement of an inpatient claim can contain literally hundreds of items, and for many of which there aren't any specific CPT codes. It would be a nightmare to try to go through all of that and add codes, and I can't imagine that it would be useful to the payer anyway.

There is one situation I can think of where a payer may want to process an inpatient claim as an outpatient claim (for example, if a patient who has part A or part B only and the payer needs to see what the outpatient portion of the services looks like separated from the inpatient room charges). That's a little different, and in that situation, they may want to see a coded outpatient claim for those same services or might request an itemized statement in order to try to make that determination. But that's not what you're describing here as putting CPT/HCPCS codes on an itemized statement, which is something I've not heard of.

 

[racker@motivhealth.com]

I've never heard of a payer asking for CPT/HCPCS codes on an itemized statement, but I don't know of any rule that says they can't ask for it. However, I think it's an unreasonable request and I wouldn't do it for them. An itemized statement of an inpatient claim can contain literally hundreds of items, and for many of which there aren't any specific CPT codes. It would be a nightmare to try to go through all of that and add codes, and I can't imagine that it would be useful to the payer anyway.

There is one situation I can think of where a payer may want to process an inpatient claim as an outpatient claim (for example, if a patient who has part A or part B only and the payer needs to see what the outpatient portion of the services looks like separated from the inpatient room charges). That's a little different, and in that situation, they may want to see a coded outpatient claim for those same services or might request an itemized statement in order to try to make that determination. But that's not what you're describing here as putting CPT/HCPCS codes on an itemized statement, which is something I've not heard of.

Thank you so much for responding and answering my questions. It is greatly appreciated.