Hospitals speak a unique financial language, and revenue codes are a big part of that story. These numeric codes are helping to translate clinical services into billable charges, which is needed so that payers understand where and how the care was delivered. Everything from imaging to anaesthesia to surgery has its own identifier. Among such, operating room revenue codes play a significant role because they capture some of the most resource-intensive services a hospital provides.

Revenue code 0360, commonly known as rev code 360, revenue code 0360, or hospital 360, is used to specify operating room facility fees related to surgical procedures. Proper application of revenue code for surgery is important. When utilized correctly, this code links the surgical CPT code with the hospital operating room facility using its fee. This ensures that complex surgical procedures are reimbursed correctly without denial. This blog provides a complete guide to operating room facilities and how a medical billing company in the USA can help with this code.

What Is Revenue Code 0360?

A Revenue Code in medical billing is a three- or four-digit code used to identify specific services or departments for which a hospital is billing. Revenue code for surgery, commonly referred to as rev code 0360, is used for billing hospital facility fees related to surgical procedures. This is an important revenue code that links operating room facility fees with proper hospital reimbursement, ensuring accurate claim processing and payment.

Definition of Revenue Code 0360

Revenue Code 0360 is a hospital billing code used on institutional claims such as the UB-04 to indicate charges for operating room services under the general classification when a surgical procedure is performed in the hospital’s main operating room. According to the official list of revenue codes referenced in Chapter 421 of the Texas Administrative Code, Revenue Code 0360 is defined as “Operating Room Services – General Classification,” which facilities must report when submitting required minimum data for services rendered in this cost center.  This revenue code is widely known as Rev Code 360 and represents the overhead cost of the hospital for using the hospital facilities rather than the cost incurred by the surgeon for his service.

Classification as an Operating Room (OR) Revenue Code

Revenue Code 0360, categorized under General Operating Room (OR) Revenue Codes, is a critical hospital revenue code used for surgical procedures. Outsourced medical billing services ensure accurate assignment of this code to correctly identify procedure location, support compliance, and optimize surgical reimbursement outcomes.

Who Uses It

The revenue code for surgery is mainly being utilized by acute care hospitals and outpatient hospital departments when sending in claims for operating room services. Sometimes, ambulatory surgery centers may refer to the 360 rev code-type classification based on payer rules, but the most common application of the 0360-revenue code is in hospital-based surgical billing, often referred to as hospital 360 in claim documentation.

Pro Tip: Always utilize the revenue code 0360 with the appropriate CPT/HCPCS procedure codes to avoid denials of claims. Regular audits of medical billing and coding services help to ensure accurate and compliant charge capture for the OR.

What Revenue Code 0360 Covers

Revenue code 0360, denoted as rev code 360 or simply 0360 revenue code, is employed in the billing process to cover the hospital costs incurred while performing the procedure in the operating room. As one of the distinct surgery revenue codes in the rev code system of medical billing, the code is necessary to cover the hospital costs incurred while performing the procedure.

Operating Room Facility Charges

All costs related to the standard facility fees incurred in the hospital’s operating room are governed by the Revenue Code 360. According to research, Under OWCP ASC payment policy, Operating Room Facility Charges are reimbursed at the lesser of billed charges or 200% of the physician rate, bundling nursing, supplies, anesthesia materials, and recovery services. These costs involve maintaining a sterile surgical setting complete with specialized equipment and personnel necessary for the safe conducting of procedures, excluding the costs of the surgeon’s professional services.

Use of OR Space During Surgical Procedures

The revenue code 0360 reflects charges related to the use of time and space in the operating room for surgical procedures. This code should be used by the hospital to indicate the utilization of the OR for patient care, thus helping payers understand the consumption of resources during surgery.

Non-Physician Overhead Related to Surgery

Revenue Code 0360 also encompasses overhead costs that are not directly related to the physician, as they might involve nursing support, surgical instruments, anesthesia supports, and operating room maintenance. Such costs for non-physicians are a very significant aspect of hospital 360 charges.

Examples of Covered Services
Services commonly processed with this revenue code include general surgical procedures such as orthopedic and cardiovascular surgeries requiring the main operating room. Healthcare revenue cycle management services ensure accurate capture of facility costs, proper charge posting, and optimized reimbursement for these procedures.

When to Use Revenue Code 0360

Revenue code 0360, also referred to as rev code 0360 or revenue code 360, is particularly used to carry hospital facility charges for operations executed in the operating room. It is critically significant to understand the rev code’s medical billing procedure concerning the appropriate utilization of this revenue code 360.

Inpatient vs Outpatient Hospital Settings

The 0360 revenue code is also used or applicable in both the inpatient and outpatient hospital settings when the patient uses any formal operating room. Though, it is indispensable for the hospital to ensure that the code provides for the care or resources consumed, irrespective of the fact that the patient was admitted or discharged the same day.

Surgical Procedures Requiring a Formal Operating Room

If the procedures involve the major operating rooms, then revenue code 360 should be used. Minor procedures performed outside the OR, even if done in procedure rooms, can also be performed using different surgery revenue codes.

Proper Placement on the UB-04 Claim Form

Under the UB-04 claim form, for the revenue code section, the rev code 360 has the label “operating room facility charges” as part of the revenue code field. This is very significant for the correct match with CPT/HCPCS codes for hospital service.

Relationship to Primary Surgical CPT Codes

Revenue code 0360 is always used along with the primary surgical CPT code describing the performed surgery. Proper pairing ensures that a full reimbursement of the hospital 360 charges reflects both the physician’s service and the use of the hospital’s facility.

Pro Tip: Revenue Code 0360 must always be matched with the primary surgical CPT code on UB-04 claims for full hospital reimbursement. Always check if the patient is inpatient or outpatient and apply the code accordingly to avoid denials.

What Revenue Code 0360 Does NOT Cover

Even though Revenue Code 0360 also referred to as rev code 360 or 0360 revenue code covers hospital operating room facility charges, it does not include all surgical costs. Medical coding services ensure correct identification of excluded components, accurate code assignment, and compliant rev code medical billing.

Professional (Physician/Surgeon) Fees

Note that the 0360 revenue code specifically only indicates the hospital facility and does not allow for inclusion of the surgeon’s professional fees. Charges imposed for a physician’s time, expertise, or surgery are entered using CPT and not revenue code 360 or other revenue codes for surgery.

Recovery Room Services (e.g., Rev Code 0710)

However, the postoperative services given in the recovery room are not included in rev code 0360. These are covered under a separate billing code, such as Rev Code 0710, to include monitoring and nursing services provided post-surgery, aside from the facility charges provided in the operating room.

Anesthesia Services (Rev Code 0370)

Revenue Code 0360 does not include anaesthesia services. Anaesthesia should be charged separately under Rev Code 0370 or the respective CPT codes. This is because it is a professional service together with drugs administered and not overhead belonging to the OR of the hospital.

Supplies Billed Separately (e.g., Implants, DME)

Any surgical supplies, such as the implants, prosthetics, and the durable medical equipment (DME), are not included in 360 rev code charges. It is important to note that they are separately billed to ensure compliance with rev code medical billing.

Revenue Code 0360 vs Related 036X Codes

Revenue code 0360 belongs to a wider group of revenue codes that pertain to surgeries, coded as 036X. The difference between these revenue codes is essential for rev code medical billing, from 0360 to 0369. The Eligibility Verification Process plays a great role within the Medical Billing cycle to ensure a proper claim, which is attained by determining the benefits as they pertain to the revenue codes.

Overview of the 036X Revenue Code Family

Codes 036X, which include codes from 0360 to 0369, constitute a set of hospital revenue codes used to classify operating room charges. While the 0360 code is used in general operating rooms, other codes in this series are used to identify specialty rooms or unique environments for surgeries.

Following are the codes used for Operating Room facility:

• 0360 General Operating Room is used for standard hospital operating room facility charges for routine surgical procedures.
• 0361 Cardiac Operating Room is applied when surgeries are performed in a specialized cardiac OR.
• 0362 Obstetric Operating Room is used for cesarean sections or other obstetric procedures requiring an OR.
• 0363 Neurosurgical Operating Room is billed when neurosurgery procedures occur in a designated neurosurgical OR.
• 0364 Orthopedic Operating Room covers orthopedic surgeries requiring specialized OR equipment.
• 0365 Pediatric Operating Room is used for surgical procedures performed in a pediatric-specific OR.
• 0366 Burn Operating Room is applied for surgeries in a burn or trauma-specific operating room.
• 0367 Transplant Operating Room covers procedures in ORs designated for organ transplant surgeries.
• 0368 Ophthalmologic Operating Room is used for eye surgeries in specialized ophthalmologic ORs.
• 0369 Other Specialty Operating Room is applied for any other specialized surgical rooms not covered by codes 0361–0368.

When to Use 0360 vs a More Specific 036X Code
0360 is the best choice for the majority of routine surgical procedures performed on a standard surgical table, for example. The more specific rev codes, 0361-0369, should be used if, according to the billing documentation, a special OR was used. This facilitates appropriate reimbursement and prevents rev codes medical billing errors for denied claims.

Pro Tip: Use 0360 for routine surgeries in a standard OR to simplify billing. Only select 0361-0369 for use in specialty operating rooms to ensure correct reimbursement. Always check documentation to avoid claims denials and correct coding errors.

Common CPT Codes Paired with Revenue Code 0360

Revenue Code 360, also abbreviated as rev code 360 or 0360 revenue code, entails hospital charges for operations carried out in the operating rooms. In order for there to be proper rev code medical billing, it is essential that pairing is achieved with the appropriate CPT code.

Typical Surgical CPT Code Ranges (e.g., 10000–69990)

The code most possible attached to 0360 is commonly used in conjunction with CPT ranges from 10000-69990 including general surgery, orthopedic, cardiovascular, and major procedures. This will ensure that the hospitals OR charges are commensurate with the actual service provided.

Examples of Frequently Paired CPT Codes
Some of the simultaneously used CPT codes with Revenue Code 0360 are 27447 (knee replacement), 33405 (heart valve replacement), 19307 (breast reconstruction), and 66984 (cataract surgery). These are standard procedure codes for operating rooms, which fall under the hospital 360 category. Additionally, therapy services such as Neuromuscular Reeducation CPT 97112 may also be billed alongside appropriate revenue codes when performed in a hospital setting to ensure accurate facility and service reimbursement.

Importance of CPT Revenue Code Alignment

It is important that there is an accurate link put in place between CPT code and 360 REV code, especially for accurate implementation of revenue codes billing in surgery. This ensures that a revenue code for a surgical procedure is an accurate reflection of resource use by the hospital.

Accurate Billing Guidelines for Revenue Code 0360

Revenue Code 0360, which is also called rev code 360 and 0360 rev code, is an important definition of rev codes in surgery, specifically referred to as charges from the hospital operating room facilities, and appropriate billing practices must be followed in order to ensure compliance with the medical billing guidelines set in rev codes.

Claim Form Requirements (UB-04 / 837I)

For the 0360 revenue code, the charge for the operating room should be indicated within the revenue code field on the UB-04 or 837I claim form. Proper completion includes stating the proper revenue code (which is 0360–0369), the dates of service, and the appropriate CPT/HCPCS codes describing the procedure performed.

Units, Charges, and Service Dates

For rev code 0360 billing, the unit number usually represents the number of hours or fractions of OR use but may vary according to payer policy. The charges should be appropriate for the documented OR use of the hospital, while the dates of service should fall on the actual date of the surgical procedure to comply with the requirements for revenue codes in the hospital.

Modifier Considerations

Modifiers may be essential in the process of billing revenue code 360 rev, especially due to the need to identify multiple procedures, bilateral procedures, or unusual occurrences in the operating room. Applying the modifiers in the correct way helps in the process of aligning surgery revenue codes with CPT codes, thus preventing underpayment or denial of claims.

Avoiding Unbundling and Duplicate Billing

Revenue code 0360 should be used for operating room facility charges and should not be used for professional fees, anesthesia, recovery room services, etc. It is advisable not to bill revenue code 0360 for services that have already been billed under some other revenue code, since it may result in an audit risk.

Documentation Checklist for Revenue Code 0360

Precise documentation is very crucial in billing 0360 revenue code, also referred to as rev code 360 or 360 rev code, for the purpose of facilitating accurate reimbursement on claims for the facility charge of hospital operating room services. Detailed documentation, therefore, supports compliance with rev codes in medical billing and facilitates the prevention of claim denials.

Operative Report

The primary documentation for billing the revenues code of 0360 is the operative report. It must include the surgical procedure, the surgical team, and any special equipment utilized in the operating room.

Date and Duration of OR Use

The date and total duration of use for each procedure should be documented, and this will help rev code 0360 and/or revenue codes for surgery translate into correct utilization costs for the hospital.

Procedure Performed

Clearly documenting the procedure rendered, such as the CPT or HCPCS code, can also assist in aligning the 360 revenue code with the service actually rendered, thus helping to comply with the hospital’s billing practices.

Medical Necessity Documentation

Medical necessity needs to be documented to justify the operating room usage and charge with the rev code 0360. In addition, the diagnosis of the patient along with the indications of the surgery are included.

Supporting Hospital Records

Additional hospital records, such as nursing notes, anesthesia records, and equipment logs, provide backup for 0360 revenue code charges. Comprehensive supporting documentation strengthens claims and reduces the likelihood of payer audits or denials.

Reimbursement for Operating Room Facility Charges

Revenue Code 0360, also abbreviated as rev code 360 or 0360 revenue code, indicates hospital operating room facility fees, which is an integral part of rev codes in medical billing services, thus ensuring that hospitals receive the rewards they need in exchange for the services in exchange for such charges.

How Payers Reimburse OR Facility Charges

Payers reimburse 360 revenue charges based on the amount of fees billed in the hospital for the OR facility and the associated CPT codes linked with the procedure, as shown in this drawing. Revenue Code 0360 is coded correctly in order to get reimbursed for the use of the operating room.

DRG vs APC Reimbursement Models

In this regard, the charges for revenue code 0360 are normally bundled into the Diagnosis-Related Group payments in inpatient settings, while in outpatient settings, the charges are divided into Ambulatory Payment Classifications. Both models outline how the charges for hospital 360 are determined for overall reimbursement.

Medicare vs Commercial Payer Considerations

Medicare has specific rules for a procedure under Rev Code “0360,” where OR charge payments may be bundled along with procedure payment, and for some commercial payers, OR facility charges may be separately reimbursed as outpatients. Hospitals should check the individual payers’ procedures to bill revenue codes for surgery properly.

Factors Affecting Payment Amounts

Reimbursement for revenue code 360 depends upon the procedure complexity, duration of OR, different contractual agreements with various hospitals, and geographic adjustments. Full reimbursement will require proper documentation, right pairing of CPT, and following the guidelines for codes that classify revenues from surgery.

Common Denials Related to Operating Room Facility Charges

The revenue code 0360 or rev code 360, or 0360 revenue code is essential for billing hospital operating room facility charges. Incorrect coding or documentation can lead to claim rejections, making denial management services crucial for identifying, correcting, and resubmitting claims to ensure accurate reimbursement.

Missing or Invalid CPT Code

A common refusal includes the lack of the CPT code or its incorrect typing with a rev code 0360. The right surgical code CPT code is coupled with the 360 revenue code to facilitate the reimbursement of the hospitals correctly and avoid rejected claims.

Mismatch Between CPT and Revenue Code

Denials may be activated by a discrepancy between the billed procedure and the rev code 360. The hospitals should ensure that CPT code relates to a procedure that is conducted in the operating room with the charge of 0360 revenue code or other suitable surgery revenue codes.

Non-Covered Procedure

The data should not be denied in case the procedure is not on the policy covered by the payer in the OR, following the hospital 360 billing rules.

Lack of Medical Necessity

One of the reasons why medical necessity is not adequately documented is denial. Justifying the utilization of the operating room to carry out the procedure is achieved by supporting the 0360 revenue code with operative reports, clinical notes, and preoperative evaluations.

Guidelines on Appeals and Corrections

To overcome refusals, reconsider the claim of CPT-revenue codes compatibility, revise documentation and resubmit with specific explanation. When properly applied as a rev code in appeals 0360, it will guarantee that all charges to the hospital OR facilities are actually reimbursed and payment is not made late.

Payer-Specific and State Rules of Operating Room Billing

Revenue Code 0360 is a billing code used to charge charges concerning operating room facilities of a hospital, but reimbursement regulations may depend on the payer or even state. These differences are critical in proper coding of medical bills and adherence to the standards of the hospitals 360.

Medicare-Specific Guidance

Medicare has specific regulations on billing of 0360 revenue code, which usually combines operating room facility charges into either DRG payments as a part of an inpatient stay or APCs as a part of an outpatient procedure. To guarantee the appropriate reimbursement of revenue code in regard to surgery charges, hospitals should comply with the rules of Medicare.

State Diversities in Medicaid

There can be state-specific regulations of rev code 0360 or 360 rev code billing in Medicaid programs. Eligible procedures, documentation and permitted charges at a facility may be different at a state-by-state level, and thus it is important that hospitals should check the local Medicaid policies.

Commercial Payer Policies

There is great variance in the way the commercial payers reimburse the charges of the 360 revenue code. Other payers reimburse the OR facility fee separately and others with the procedure one thereby requiring the hospital to ensure that it identifies the particular policy of a specific payer when using 0360 revenue code.

Significance of Reviewing Payer Contracts and Fee Schedule
To guarantee proper billing of the rev code 360, payer contracts, fee schedules, and policy updates should be reviewed regularly by the hospital. This will avoid reimbursement of claims, assist in proper utilization of surgery revenue codes, and allow the operating rooms facility charges to be reimbursed to their fullest.

How iSolve RCM Supports Revenue Code 0360

The billing under Revenue Code 0360, which is also known as rev code 360 or 0360 revenue code, is paramount in ensuring that hospitals receive the correct reimbursement on operating room facility charges. iSolve RCM makes it easy to do this by automating the validation of the code, checking the alignment of codes with CPT revenue codes, and ensuring that the rules they apply to the hospital 360 and other surgery revenue codes are correct. Using iSolve RCM, hospitals are able to minimize claim denials, ensure that they meet the requirements of rev code medical billing standards and optimize reimbursement besides streamlining documentation and reporting of charges incurred in the OR facility.

FAQs

What is the revenue code for medical billing?

UB-04 claims contain four-digit facility codes on revenue codes indicating hospital departments or services offered, the payers use these facility codes to group charges and therefore make payments, conduct reporting and billing compliance analysis.

What is a hospital revenue code 0361?

A hospital revenue code 0361 is an operating room service, which involves the use of surgical facilities and supplies which are reported on facility claims on any procedure performed in the hospital operating room in inpatient or outpatient.

What is the CPT code 36000 used for?

CPT code 36000 is utilized in the introduction of a needle or intracatheter into a vein usually in clinical and hospital outpatient environments and can be applied in venipuncture, IV access or diagnostic blood sampling.

What is the difference between rev code 360 and 490?

The use of revenue code 360 and 490 is operating room services and ambulatory surgical care, respectively, which are normally used in inpatient surgery and outpatient operating room services, respectively.

What rev codes require HCPCS?

Supply, DME, drug, or non-routine service related revenue code will often need HCPCS or CPT code to detail the exact service or product being billed to be accurately reimbursed and billed by the payer.

Can you bill a revenue code without a CPT code?

Yes, certain revenue codes may be billed without CPT codes, especially room-and-board or routine services, however, most outpatient and procedure services need CPT/HCPCS code to have an accurate payer reimbursement.