Box 43 - Revenue Code Description

Box Definition 

Box 43 displays a description or standard abbreviation for the revenue code shown in Box 42 on the same line. This field is not required. The payer commonly assigns Revenue code descriptions when the claim file is accepted for processing.

In Kipu RCM

Custom revenue code descriptions are stored in the Claim Form Service Name field in the service billing profile. However, this description is not included on the claim file by default and can only be added using a claim rule. Let's review how to update Box 43 in the RCM!

• The Claim Form Service Name field within the Service Billing Profile fills box 43 when a claim rule is in place. For more information on updating the billing profile, click here. For information about creating a claim rule to include the description on a claim, click here. 
• A Service Grouping Rule can be used to update the Claim Form Service Name by updating the billing profile used when creating a claim. However, a Claim Form Rule will always be required to ensure the revenue code description is included when the claim is created. For information on that rule, click here.  
• The Revenue Code Description can be included on a claim before submitting it using our Claim Edits feature. To learn more about this feature, click here.

EDI Loop and Segment

Loop 2400, Segment NTE. For additional information on loops and segments, click here.