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Provider Handbook
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Revenue Code 76x
Billing with V Codes
Choose the Correct V Codes
How to Bill with V Codes |
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Proper Treatment Room Billing |
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Revenue Code 76x |
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Determining when to use revenue code 76x (treatment or observation room) to indicate use of a treatment room can be confusing, and improper coding can lead to inappropriate billing.
The TRICARE Outpatient Prospective Payment System (OPPS) reimbursement methodology is scheduled to be implemented for claims in the fall of 2007. Note: The implementation date may be impacted by legislation or other policy changes. Payment of 510 and 760 series revenue codes will be based on the HCPCS codes submitted on the claim and reimbursed under Outpatient Prospective Payment System (OPPS). Refer to the TRICARE Reimbursement Manual Chapter 5, Section 3, III.E.3.C.(2).
You may indicate revenue code 76x for the actual use of a treatment room in which a specific procedure has been performed or a treatment rendered. Revenue code 76x may be appropriate for charges for minor procedures and in the following instances:
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- An outpatient surgery procedure code (10021-69990)
- Interventional radiology services related to imaging, supervision, interpretation, and the related injection or introduction procedure
- Debridement (11040-11044) performed in an outpatient hospital department
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Revenue code 76x should not be used when the claim is submitted with a type of bill 83x and ASC procedure codes. ASC facility services are reimbursed under the ASC grouper reimbursement or OPPS. It should also not be used when the HCPCS code is blank or is an evaluation and management code (e.g., 99201-99205, 99211-99215). |
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Billing with V Codes |
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Humana Military and PGBA remind you that it is especially important to use the proper V codes for claims reimbursement. A V code may designate a primary diagnosis for an outpatient claim that explains the reason for a patient’s visit to your office. V codes should be used for preventive or other screening reasons; all other claims should be billed with the standard numeric ICD-9 diagnosis codes.
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Choose the Correct V Codes |
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Be sure to use the correct V-code diagnosis to indicate the reason for the visit. The V code must match the CPT code to indicate the procedure that you are performing as it correlates to the V-code diagnosis. |
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How to Bill with V Codes |
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V codes correspond to descriptive, generic, preventive, ancillary, or required medical services and should be billed accordingly. |
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Descriptive V Codes |
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For V codes that provide descriptive information as the reason for the patient visit, you may designate that description as the primary diagnosis. An example of a descriptive V code includes a routine infant or child health visit, which is designated as V20.2. |
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Generic V Codes |
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For generic non-payable services, such as lab, radiology, or preop, you should not use a generic V code as a primary diagnosis. Rather, the underlying medical condition should be listed as the primary diagnosis for these ancillary services. |
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