What Is Revenue Code 259 for Intensive Care?
Discover the role of Revenue Code 259, the billing code used for intensive care stays that fall outside of specialized ICU classifications.
Revenue codes are four-digit numbers on hospital bills that categorize the services a patient receives for insurance payers. They tell an insurer whether a charge is for a room, a lab test, or a specific type of therapy. Understanding these codes can help patients and families make sense of detailed medical bills, particularly when it comes to charges for intensive care.
Defining the Code for Intensive Care
A frequent point of confusion is the purpose of Revenue Code 259. While sometimes mistaken as an intensive care code, its official designation by the National Uniform Billing Committee (NUBC) is for “Other Pharmacy” services. This means the code is used to bill for pharmaceutical items that do not fit into more specific pharmacy categories. When Revenue Code 259 appears on a bill, it represents a charge from the hospital’s pharmacy for a miscellaneous medication or supply.
The correct code for intensive care services that are not otherwise specified is Revenue Code 209, titled “Other Intensive Care.” Hospitals use this code for intensive care accommodations that do not fall into a more precise category. For example, if a hospital has a multi-purpose ICU that treats a wide range of critical conditions without being specialized, the room charges for that unit would likely be billed under code 209. It serves as a general classification for high-level patient care that is not exclusively surgical, cardiac, or pediatric.
This distinction is important for ensuring claims are processed correctly. Using the wrong revenue code can lead to payment delays or denials from insurers. Revenue Code 209 signifies a bed in an intensive care unit, whereas Revenue Code 259 points to a charge from the pharmacy department. These codes represent different aspects of a patient’s hospital stay and are never used interchangeably.
Application in Hospital Billing
Patients encounter these codes on the institutional claim form, known as the UB-04. This standardized document is used by hospitals to bill insurance companies. On the UB-04 form, each service or accommodation is listed as a separate line item with the four-digit revenue code that identifies the charge. A stay in a non-specialized ICU would appear as a line item with Revenue Code 209.
The revenue code’s function is to categorize the charge for the payer, indicating the department where the service was provided. It works with other information on the claim, such as procedure codes, to create a full picture of the patient’s treatment. The revenue code for an ICU stay, like 209, represents the accommodation or “room and board” charge for that level of care, covering specialized nursing and monitoring.
The revenue code for the ICU room is separate from the charges for physician services. The professional fees for doctors who treat the patient in the ICU are billed separately and do not use the hospital’s revenue codes. The UB-04 form is strictly for the hospital’s or facility’s charges.
Relation to Other Intensive Care Codes
The purpose of Revenue Code 209 as “Other Intensive Care” becomes clearer in the context of the broader 20x series of codes, which are all designated for intensive care units. The NUBC has established highly specific codes for specialized ICUs to allow for more precise billing. For example, a stay in a unit for patients after major operations is billed under Revenue Code 201 (Surgical ICU), and care for severe burn injuries is categorized under Revenue Code 207 (Burn Care ICU).
These specific classifications demonstrate why a general code like 209 is necessary. Not every hospital has the patient volume to support numerous specialized ICUs. Many facilities operate mixed-use or general ICUs that handle a variety of critical cases. Revenue Code 209 provides a standardized way to bill for this type of accommodation.
Other codes in this series include 203 for a Pediatric ICU, 204 for a Psychiatric ICU, and the 21x series for Coronary Care Units (CCU). Each code allows the hospital to accurately represent the level and type of resources used for the patient’s care. This system enables insurers to properly reimburse hospitals based on the intensity of the services provided.