Wiki Wellcare UB04 revenue codes

[erinlee90@gmail.com]

Hello,
I work in outpatient follow up of denied claims and I work closely with my biller, but we seem to be stuck on a few denials regarding invalid revenue/procedure code combinations. To be exact, these are CT scans. I work for a mulit-specialty hospital, heart, lung, vascular specialties. Example this morning would be CPT 75571 and CPT 71250 billed with 0329 being denied. The revenue codes given to try to rebill are 0350, 0351 0352 or 0359. 0351 and 0352 are head and body, 0359 is too broad, would anyone recommend 0350? The payer is Wellcare NJ, both Medicare and Medicaid plans. Not all payers have a revenue reference list on their provider portals or elsewhere. Any input would be appreciated. Thank you!

 

[sls314]

Hello,
I work in outpatient follow up of denied claims and I work closely with my biller, but we seem to be stuck on a few denials regarding invalid revenue/procedure code combinations. To be exact, these are CT scans. I work for a mulit-specialty hospital, heart, lung, vascular specialties. Example this morning would be CPT 75571 and CPT 71250 billed with 0329 being denied. The revenue codes given to try to rebill are 0350, 0351 0352 or 0359. 0351 and 0352 are head and body, 0359 is too broad, would anyone recommend 0350? The payer is Wellcare NJ, both Medicare and Medicaid plans. Not all payers have a revenue reference list on their provider portals or elsewhere. Any input would be appreciated. Thank you!

I'd always use a 35x revenue code for a CT scan. (32x is Diagnostic Radiology, and 35x is Computerized Axial Tomography. If you're doing a CT scan, you should always use a 35x code.)

You'll want to have your chargemaster corrected to ensure that the correct revenue codes are associated with your CT scan codes. There should be no reason why a 329 is the default code dropping into your system for a CT scan.

Do you (or your employer) have a copy of the Uniform Billing Editor (UB04 Manual)? Someone at your facility should have one - it contains all of the official rules for billing UB04 claims, and most insurers follow it.

I'd probably use 350 for 77571 and 352 for 71250.