Name of Manual - Blue Cross and Blue Shield of Minnesota

Blue Cross Blue and Shield of Minnesota Provider Policy and Procedure Manual (07/12/12)
Coding Policies and Guidelines (Coding)
Revenue Codes Revenue codes are developed by the National Uniform Billing
Committee (NUBC) and are used to identify specific
accommodation charges, ancillary service charges, or a type of
billing calculation. They are only to be submitted on the
institutional electronic claim format (837I).
Format
Revenue codes are four digits in length. The first three digits
define the category and the fourth digit defines the subcategory. It
is important for the subcategory to be properly defined for
appropriate payment. For example: 012X is the category for
“Room & Board-Semi-Private (Two Bed)”. While 012X indicates
the type of accommodations it does not identify the department or
area in the hospital where the patient is staying. However, the code
0122 (Obstetrics (OB) would properly indicate a semiprivate room
in the OB.
The list of revenue code is extensive and can be found in the
NUBC UB 04 manual under FORM LOCATOR
SPECIFICATIONS, form locator 42.
HIPAA transaction standards require submission of HCPCS/CPT
codes on outpatient facility claims. Guidelines for submission of
HCPCS/CPT codes including modifiers can be found in the UB-04
manual under FORM LOCATOR SPECIFICATIONS, form
locator 44.
Compatibility HCPCS and ICD-9-CM Codes
Blue Cross requires that diagnosis codes and procedures performed
be compatible. These conditions are identified separately not only
to assure correct coding, but also appropriately apply benefits.
A chart of injury, maternity and behavioral health conditions and
the compatible diagnosis codes or ranges is found below. Note that
this is a general guide only and is not all inclusive. All diagnoses
must be reported to the fullest specificity.
Condition Compatible Diagnosis Code/Code
Category
Injury 800-977, 980-994, V15.51, V15.59,
V15.6, V66.4, V67.4, V71.3-V71.4,
V71.6
Maternity 630-677, V22-V24, V27, V28
Chemical dependency 303-305. V79.1
Psychiatric care 291-302, 306-319, V11, V40, V70.1-
V70.2, V71.01-V71.09
11-9