Complex variables addressed in coding for ambulance and EMS units require heightened diligence and exceptional attention to a larger scope of factors. Exclusive to the field of ambulance and emergency medical services are distinctive code sets that are not purposed for physician or hospital services and require specialized coding methods.
Factors included in ambulance and emergency services coding:
- Ambulance services with differing levels of care and condition. Emergency and non-emergency services.
- Over 30 advanced Life Support (ALS) condition codes.
- Total of 12 HCPCS Level II Procedure Codes Multiple modifiers related to origin and destination
- Situational modifier codes
- Ground Mileage
- Non-covered mileage
- Air services; rotary and fixed wing
- Air mileage; rotary and fixed wing
Standard modifiers and HCPCS Level II procedure codes are used in addition to other, separate and specific, modifiers to succinctly pinpoint origin and destination. These modifiers are to be joined to the procedure code. All of these factors influence Medicare coverage determinations and are therefore essential to claim reimbursement.
Special attention should be paid, by emergency medical technicians and coders alike, to code applications relative to medical condition. Due to HIPAA compliance policies, CMS has not relaxed their requirements for proper diagnosis coding which, for ambulance services and EMS, translates to higher expectations with regard to condition codes. EMT’s are unable to diagnose which, as a result, entails using extremely specific and accurate accountings of the patient’s condition in terms of symptom description, signs of trauma, laterality, and level of severity through recording case particulars. The facts recorded will determine the diagnosis code used for claim purposes. The ICD-10 expands the need for detailed specificity. Failure to apply ICD-10 CM rules will result in prolonged processing, denials and rejections, interruption of cash flow, and backlogs in coding and billing.
Claims are broken-down into 7 categories denoting precise ground services:
- BLS – Basic life support non-emergency
- BLS Emergency – Basic life support emergency
- ALS1 – Advanced life support non-emergency
- ALS1 Emergency – Advanced life support emergency
- ALS-2 – Advanced life support, level 2 (emergency status presumed)
- SCT – Specialty care transport (emergency status presumed); inter-facility transport.
- Ground Mileage – Per statute mile.
The vast differences in coding for ambulance and emergency medical services, in terms of the sheer number of relevant elements in a singular occurrence, demands professional, skilled coders to successfully translate services into reliable compensation returns. Employing consistent, knowledgeable coders that can fulfill these requirements is a daunting task. Professional Dynamic Network, Inc. offers medical and ambulance coding services provided by certified, licensed, expert coders to fill the void. Improve claim acceptance rates, increase revenues, and minimize fixed expenses with PDN’s staff of exceptional ambulance and EMS coders.
PDN Coding Services:
- Temporary, part-time, or permanent solutions for your ambulance and EMS coding needs.
- Resolve coding backlogs and transition to a timely, efficient payment cycle.
- RAC -Recovery Audit Contractor.
- Remote coding lab that has the ability to work for your business on a 24 hour basis.
- Education, training services, and seminars.
- Our knowledgeable, certified coders produce a reliable and compliant work product that that can be counted on to keep ambulance and EMS services running smoothly.
- HIPAA compliant coding services.