USCORE Procedure profile - facility claim with no procedure code


For procedure code profile what do we do if a facility claim has no procedure code just revenue code. For example claim with revenue code Operating room services may not have procedure code billed on claim. Can we then pull revenue codes into the procedure code profile, in absence of procedure codes?

In US Core, you’re required to use a code from CPT, SNOMED CT, HCPCS Level II, ICD-10-PCS or CDT if one applies. If the concept isn’t expressed in one of those, you’re required to map and translate as best you can. You’re free to send your revenue code and/or a textual description as well, but you must provide a code from the value set if one applies - and because SNOMED is so broad, it’s a given that any procedure you might give is guaranteed to have a code in at least one of those code systems.

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Thanks lloyd. That helps.