Exceptional Scenarios in Ambulance Transport


There are some special cases where the ambulance transport is required. For instance, when the patient is bed bound or some other conditions prevent them from using an alternative mode of transportation. Suppose the patient is going to the hospital for cardiac characterization or vascular characterization. The characterization services, whether they are diagnostic or therapeutic, or both, are going to be separately paid under APCs— assuming that it's outpatient or under DRGs if it's inpatient. Then that's an exception to the payment to the skilled nursing facility. And in this case, the ambulance services are going to become separately payable. The trick is to figure out which are which. And you have to follow Medicare very closely. Every year, the providers should look at the transmittals to see what's included in the SNF payment and what's excluded. And yes, we have transmittals that give us all of that information. So it’s imperative to keep up-to-date relative to SNFs.

As per our expert in healthcare coding conference, when it comes to HCPCS codes, whether you use them or not depends upon the third party payer. Medicare program under the ambulance fee schedule tend to bundle everything. And when it comes to extra ambulance attendant, the Medicare program isn't going to pay you extra for having an additional attendant. They're going to pay you the base rate that's appropriate for the services being provided. So, here are some additional HCPCS codes, you may have private third party payers that will pay for some of these things— Ambulance waiting time. Or A0422, the ambulance oxygen, that was something that we could get separately paid for. But again, since we've gone over the ambulance fee schedule for the most part, you're going to find that things are pretty much bundled and these additional HCPCS codes are not going to be particularly relevant.

If you go to Chapter 15 of Publication 100-04, Section 30.3, it's the ambulance chapter in the Medicare claims processing manual. And ambulance providers should swear by this information packed manual for any query. So, the Chapter 15, Section 30.3 talks extensively about the medical conditions. And as they indicate in the manual, these are primarily educational guidelines. It will help ambulance providers and suppliers to communicate the patient's condition to Medicare contractors as reported by the dispatch center and as observed by the ambulance crew. Okay. So we have transportation indicators. And then we have the medical conditions list, which gives in to ICD-9 coding -- primary, alternative specific code, condition -- general versus specific, et cetera. Then we have a HCPCS crosswalk from the ICD-9, but many of which are symptoms. And then we have a crosswalk over to the appropriate HCPCS codes as to whether it's BLS, ALS, et cetera.

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