Revenue Code 1002 (Inpatient) and Revenue Code 0915 (Outpatient) facility bill

[Mandy1986]

Hello ,

Can we bill concurrently for two levels of care. revenue code 1002 RTC-substance abuse and therapy 915 on same day to payor ?

if yes how and if insurance ask what would be you suggestion .

 

[Michele]

You can bill for both, but the patient's plan will determine if they both will be allowed.  If you call prior to get authorization I would ask at that time.  If the room & board is all inclusive then most likely they would consider the therapy as included with the room & board, but if it's not, they may allow for the therapy separately.

[Nick D]

I haven't encountered a payer that did not consider Rev 1002 to be an all inclusive code. They see it as a per diem charge and deem any additional charges as unbundled.

Rev code 0915 is used to show OP which together would be like billing for two separate levels of care.. I'd strongly advise against billing the two together. I can smell an audit coming from UnitedHC already.

[Michele]

Thanks Nick.  I haven't billed inpatient in a while but I thought the 1002 was usually all inclusive.