HealthCare News

Revenue Code 71X – Recovery Room on Non-Surgical Claims

Issue: #397 NOV2017

Topic: Coding/Billing


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.

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