Revenue Code 71X – Recovery Room on Non-Surgical Claims
Issue: #397 NOV2017
Recovery room services are provided to patients who are monitored by staff until they regain consciousness and are no longer drowsy and stuporous from the effects of anesthesia. A recovery room is generally used for approximately two to four hours after a surgical procedure or other service requiring anesthesia or sedation. Revenue code 71X identifies recovery-room services and is commonly seen on an outpatient surgical claim. BCBSND will reimburse the recovery-room service based on a fee schedule amount when a recovery room (revenue code 71X) is billed without a HCPCS code on a non-surgical claim. Reimbursement for recovery-room services will be the lesser of charges or the fee schedule amount. When recovery-room care is present on a surgical claim, the recovery-room charges will continue to be included in the surgical roll-up methodology.
The following will apply to revenue code 71X on non-surgical claims:
- Revenue code 71X does not require HCPCS. When billed without HCPCS, reimbursement will be the lesser of charges or the recovery-room fee schedule amount.
- If a rated HCPCS is submitted on revenue code 71X, reimbursement will be the lesser of charges or the fee schedule amount for the billed HCPCS.
- If a non-rated HCPCS is submitted on revenue code 71X, reimbursement will be the lesser of charges or the recovery room fee schedule amount.
- Only one line of revenue code 71X will be accepted.
- Recovery-room charges are not to be used in place of observation-room (revenue code 762) charges.
- Claims will be reviewed on a post-pay basis for appropriate coding.
In an effort to clean up HealthCare News, we will be reviewing past articles. Articles that are no longer relevant will be archived. Articles found in this section are still relevant and are being republished.