A Guide On How To Bill For Ambulance Rides Correctly
Did
you know? Ambulance codes and guidelines apply only to non-physician providers.
As the CPT codebook lacks procedure codes relevant to emergency medical service (EMS)
providers,
this makes Bill for Ambulance Rides services even more difficult.
Instead,
ambulance and EMS transport coding guidelines are primarily derived from
Medicare transmittals and MedLearn updates.
Payers
typically cover ambulance services, including fixed and rotary-wing services,
for patients whose medical condition necessitates air transport. To ensure that
transportation is medically necessary, consider both the patient’s condition
and the mode of transportation.
This
can be a difficult process that is dependent on the documentation provided by
paramedics and emergency medical technicians (EMTs) covered in this blog.
Bill for Ambulance Rides
Guidelines
- The
CMS-1500 is used to bill
for ambulance rides services provided by an independent ambulance
provider.
- Ambulance
claims must be submitted separately as an outpatient claims.
- Codes
should be assigned based on the level of service provided rather than the
type of vehicle used.
- Unless
the patient was not transported, each claim should include a mileage code.
- Ambulance
transportation to a clinic or mortuary is not reimbursable.
Ambulance Rides CPT Codes
There
are CPT codes for ground ambulance services, which include both land and water transportation,
and the codes are chosen based on the services provided and the patient’s
condition at the time of transport.
A0425: Ground mileage, per
statute mile.
A0426: Ambulance service,
advanced life support, non-emergency transport (Level 1)
A0427: Ambulance service,
emergency transport, advanced life support level 1 (ALS1-emergency).
A0428: Ambulance service,
basic life support, non-emergency transport (BLS).
A0429: Basic life support,
Ambulance service, emergency transport (BLS-emergency).
A0433: Advanced life support, ALS2
A0434- Specialty Care Transport
(SCT)
Break Down of Ambulance Services Categories
There
are seven categories of ground ambulance services (“ground” refers to both land
and water transportation) and two categories of air ambulance services in the
Ground Ambulance Services section of the ambulance fee schedule. The level of
service is determined by the patient’s condition rather than the vehicle used.
This is a difficult task for many coders.
In
addition to the HCPCS, Level II procedure codes, and standard set of modifiers,
a unique set of modifiers that are affixed to the procedure code are required
to identify the origin and destination. Mileage must also be calculated, which
adds complications if this information is not clearly documented.
Modifiers for First Position: Alpha Code Equals Origin
D:
Diagnostic or therapeutic site other than P or H when used as origin codes.
E:
Residential, custodial, domiciliary facility
G:
Hospital-based ESRD facility
H:
Hospital
I:
Transfer site (e.g., airport or helicopter pad) between modes of ambulance
transportation
J:
Freestanding ESRD facility
N:
SNF
P:
Physician’s Office
R:
Residence
X:
Intermediate stop at physician’s office on the way to the hospital
Modifiers for Second Position: Alpha Code Equals
Destination
CR:
Concerned with a catastrophe or declared disaster
GA:
ABN was required and obtained
GM:
Various modes of patient transportation
GX:
ABN was optional and obtained
GY:
Service that is statutorily prohibited
GZ:
ABN was required but not obtained
QJ:
Incarcerated patient
QL:
Patient pronounced dead after ambulance called
QM:
Under the arrangement
Most Common Ambulance Errors
The
following are the most common ambulance billing errors:
- No
PCS submitted or obtained with the documentation (when demanded)
- Only
‘loaded’ ambulance miles are reimbursed by Medicare.
- The
documentation did not back up the reported condition (s).
- Despite
the submission of a valid ICD-9 code(s), the ICD-9 code alone had
insufficient information.
Tips for Error-Free Ambulance Claims:
The
following tips should be implemented to submit the error-free ambulance rides
billing claims:
- Although
the patient may have required an ambulance ride to the hospital, you must
consider whether they still meet coverage criteria for the return trip.
- Confirm
that the patient’s origin and destination are covered by Medicare.
- Could
the patient have gone another route safely?
- Did
the patient’s condition meet the coverage criteria?
- Are
the mileage, origin, and destination specified?
- Attendant/EMT
credentials must be included.
- Do
you have a PCS? Is your certification still valid?
- Do
you require a hospital, nursing home, or other third-party records to
support the service bill for ambulance rides?
What Else?
Successful
management of ambulance rides billing
and coding is proving to be a strategic advantage point for providers
in today’s complex and evolving healthcare marketplace. No surprise, practices
have embraced billing and coding outsourcing as a trump card for improving
bottom lines. 24/7 Medical Billing Services, a professional and HIPAA compliant
healthcare and health plan processing firm, has become the ideal choice for
hundreds of American physician and non-physician providers. Medical billing outsourcing hasn’t just gotten a
foot in the door as a cost-cutting savior. In fact, it is driving the trend for
clients, as they increasingly see it as a tool that provides broader business
benefits.
About 24/7 Medical Billing Services:
We are a medical billing company that offers ‘24/7
Medical Billing Services’ and support physicians, hospitals, medical
institutions and group practices with our end to end medical billing solutions.
We help you earn more revenue with our quick and affordable services. Our
customized Revenue Cycle Management (RCM) solutions allow physicians to attract
additional revenue and reduce administrative burden or losses.
Contact:
24/7 Medical Billing Services
Tel: +1 888-502-0537
Comments
Post a Comment