Revenue code 636, reported as 0636 on UB-04 and 837I claims, is the pharmacy revenue code for drugs requiring detailed coding. You put it on a facility claim line when a drug has its own HCPCS code, so the payer can see exactly which drug was given, how much, and whether it should be paid […]
Revenue code 0250 is the UB-04 code for general pharmacy charges. It tells the payer that a line on a facility claim came from the hospital pharmacy. It does not name the drug. The drug is identified separately through HCPCS codes, NDCs, and units, and that pairing is where most 0250 claims succeed or fail. […]
CO-45 means the amount you billed is higher than the payer’s allowed amount under its fee schedule or your contract, so the payer adjusted the difference off the claim. The “CO” stands for contractual obligation, which makes that amount your write-off, not something you can bill the patient. Despite the name most people give it, […]
A patient walks in with a tick still attached to their scalp, or a red mark on the thigh where one was pulled out that morning. The clinical part is usually quick. The coding part is where things go sideways, because a tick bite is one of the few common encounters that legally cannot be […]
A superbill is an itemized statement of a patient encounter that a provider gives directly to the patient instead of billing the insurance company. It lists the diagnosis codes, procedure codes, provider information, and charges for a visit, and the patient submits it to their insurer to ask for reimbursement. It is not a bill […]
If you’ve landed here because a claim for an endometrial biopsy just bounced back, you’re not alone. This is one of the most billed OB/GYN office procedures in the country, and it’s also one of the most quietly denied ones. Not because the coding is hard. It’s because the small details, the modifier on the […]
Somewhere inside a 70,000-plus code system built to track human illness and injury, there is an official diagnosis code for getting struck by an orca. There is another one for being burned by water skis that caught fire mid-ride. Read that twice. It still sounds made up. It isn’t. ICD-10-CM, the diagnostic code set every […]
If you’ve ever sat in a coding training session and stumbled across “Struck by turtle” or “Sucked into jet engine, subsequent encounter,” you probably laughed out loud and then wondered the same thing everyone wonders: is this a joke, or is this actually in the system? It’s real. All of it. The ICD-10-CM code set […]
There isn’t one single ICD-10 code for an EGD, and that’s exactly where a lot of billing teams get stuck. An esophagogastroduodenoscopy is a procedure, not a diagnosis, so it’s reported with a CPT code (43235 through 43270) on the claim, while an ICD-10-CM diagnosis code sits right beside it to explain why the scope […]
CPT 99213 is the E/M code you bill for an office visit with an established patient when the medical decision-making is low complexity, or when the provider spends 20 to 29 minutes on the encounter on the date of service. It’s the single most-used outpatient code in American medicine, and it’s also one of the […]
