What Is Revenue Code 812 in Medical Billing?

Revenue Code 812 is a four-digit code used by healthcare facilities for billing. Despite the term “revenue,” it is not a tax code related to the IRS. Instead, it is a standard code found on the UB-04 facility claim form that tells an insurance payer the general category of a charge. Revenue Code 812 is part of the 81x series, which pertains to donor services and signifies charges related to cadaver organ or tissue acquisition.

Scope of Pharmacy Services Covered

The broader category of pharmacy services is captured under different revenue codes, most notably the 25x series. In some billing scenarios, pharmacy-related items might be bundled under a broader service code. When pharmacy charges are itemized, they fall into distinct categories. Revenue Code 250 is a general classification for the pharmacy department, while more specific codes identify the type of drug.

Specific codes can include categories for generic drugs, branded drugs, non-prescription items, IV solutions, or other pharmaceutical products. These codes allow a hospital to bill for the actual medications dispensed to a patient during their stay or upon discharge. This detailed categorization helps insurers understand what pharmaceutical products are being paid for.

Drugs administered in an outpatient setting are billed using a combination of a revenue code and a Healthcare Common Procedure Coding System (HCPCS) code. For example, chemotherapy drugs are identified by codes in the 33x revenue code series. This system categorizes high-cost, specialized drugs separately from general pharmacy charges for reimbursement and tracking.

Facilities also bill for non-diagnostic or non-therapeutic drugs, which are substances necessary for a procedure but not used to treat a condition. Examples include a saline flush to keep an IV line clear or heparin to prevent clotting in an IV lock. These items have associated costs and are billed to payers using pharmacy revenue codes to ensure the facility is compensated for all supplies.

Application in Medical Billing

Revenue codes are applied on the UB-04 claim form, where each service or supply is a separate line item. The four-digit code is entered in the designated field for each line. This code tells the payer the general department or type of service provided, such as “Pharmacy” or “Emergency Room.”

This coding is associated with services in an outpatient context, including emergency room visits, outpatient surgeries, or services at hospital-affiliated clinics. For example, if a patient receives a tetanus shot in the emergency room, the bill would show one revenue code for the ER visit and another for the pharmacy charge for the vaccine.

The revenue code groups charges into standardized categories that are understood across the healthcare industry. When an insurer’s system processes a claim, it reads the revenue code to understand the nature of the charge. This classification is the first step in the payer’s process of determining if the service is covered and how much should be reimbursed.

While a patient’s bill may translate these codes into plain language, the claim sent to the insurer is built around the numeric system. The total charge for all services under a specific revenue code is listed next to it. This structure allows for an organized submission of all costs incurred.

Coordination with Other Billing Codes

A revenue code alone is not enough for an insurer to process a claim, especially for drugs, as it does not specify the medication administered. To provide this detail, the revenue code must be paired with a code from the Healthcare Common Procedure Coding System (HCPCS).

For physician-administered drugs, billers use alphanumeric HCPCS Level II codes, also known as J-codes, which represent specific medications and dosages. For an injection, the claim would list the pharmacy revenue code alongside the specific J-code for the drug. This level of detail allows payers to verify medical necessity and apply correct payment rules.

If a clinical service was performed to administer the drug, Current Procedural Terminology (CPT) codes are also used. These codes report medical procedures performed by healthcare professionals. A claim for a drug injection would therefore include a CPT code for the injection service, the revenue code, and the HCPCS code for the drug.

This coordination is similar to a retail transaction. The revenue code is like the store department, such as “Electronics.” The HCPCS code is the specific product’s barcode, and the CPT code is an associated service, like “Installation.” All three pieces of information give the insurer a complete picture to reimburse the hospital accurately.