Missing Nursery Level II Charges (revenue code)?

Published May 22, 2009

1 Post

Hi Everyone,

Hope you can help me with this question, which involves revenue codes corresponding to the four nursery levels (I, II, III, and IV). Thanks in advance!

My hospital has NICU, which makes me assume it is equipped to provide nursery level I care (normal newborn - revenue code 171), nursery level II care (transitional - 172), nursery level III (173), and of course level IV (NICU - 174).

However, in billing the payers, we only use Revenue Codes 171, 173, and 174, seemingly skipping 172 for nursery level II. I have a suspicion that we are not adequately mapping our charges and we should be billing Revenue Code 172 for nursery level II services! In fact, it appears that charges that belong in 172 are actually going to 171, because many of these patients have ventilator services and yet are being billed to 171.

On the back end, this means payers are paying level II services at level I rates, which, spread across thousands of accounts, implies they are underpaying quite a bit. Have you ever encountered something like this? Am I correct in suspecting that we should be billing level II services with Revenue Code 172 for sure? Is there ever any situation when it's correct to do otherwise?

THANKS SO MUCH FOR YOUR HELP / ADVICE / OPINION! This would mean a lot to me as this is such a unique issue.

Stephen