EMERGENCY
ROOM
OUTPATIENT
SERVICES
TRAINING PACKET
TABLE OF CONTENTS
DESCRIPTION
PAGE
Break down of CPT codes and Revenue codes………………………. 5
Flat Rate Payments……………………………………………………… .. 6
Claim Example 1 Revenue Code 451 (Triage) ……………………… .. 7
Claim Example 2 Revenue Code 450 (ER) .……………………………… 9
Claim Example 3 Inpatient Claim …………………………… …… … 11
Claim Example 4 Professional Fees ………..…………… ………. . ... 13
Reading Your Remittance Advice ……………………………… ………15
Forms ..……………………………………………………………… ……. .. 17
Unisys Provider Representative Listing ……………………… …….… 21
Obtaining Billing Instructions …………………………… …………… .22
Updated payment system for Emergency Room services to reflect
new policy for outpatient hospital provider type 01.
EFFECTIVE SEPTEMBER 1, 2002
1. ER rates for provider types 01, current type of bill 131 (UB92). To
be paid as “fee for service,” with flat rate billed with two revenue
codes 450 and 451 reflecting levels of service. These revenue
codes are to be inclusive of the majority of services with a few
exceptions.
2. Revenue codes 450 must be billed with one of the following, if not
the claim should deny.
CPT code 99281 = Level 1
CPT codes 99282 & 99283 = Level 2
CPT codes 99284, 99285, 99291 & 99292 = Level 3
3. Revenue Code 450:
If the following revenue codes are billed with revenue code 450 then
payment would be only from amount determined due for revenue code 450
and appropriate CPT code.
Lab
300, 301, 302, 303, 304, 305, 306, 307, 310, 311, 312, 314,
380, 381, 382, 383, 384, 385, 386, 387, 390, 391, 923, 924, 925
X-Ray
320, 321, 322, 323, 324, 330, 342, 400, 403, 920
Supplies
270, 271, 272, 274, 275, 621, 622, 623
Pharmacy
250, 251, 252, 254, 255, 258, 260, 261, 634, 635, 636
EKG/ECG
Therapeutic
Services
410, 412, 413, 420, 421, 422, 423, 424, 440, 441, 442, 443,
444, 460, 470, 471, 472, 480, 482, 510, 512, 516, 517, 730,
731, 732, 740, 901, 922, 940, 942, 943
Rooms &
Miscellaneous
280, 290, 370, 371, 372, 374, 700, 7