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ICD10-CM Documentation Training for Ambulance Providers

VikkiLindemuth Vikki Lindemuth
Professional Relations Representative - BCBSKS

NancyRatzlaff Nancy Ratzlaff
Billing Director - LifeTeam

TanyaRatzlaff Tanya Ratzlaff
Coding and Documentation Specialist - LifeTeam

Blue Cross and Blue Shield of Kansas and LifeTeam Critical Care Ambulance Service is pleased to provide information with regard to ICD10 coding and documentation for Ambulance providers. This is your chance to get billing, admin and medical crews through the documentation training necessary to help get your claims paid and your patients taken care of in the wake of ICD10.

Questions and Answers from Live Webinar

Do you need an ABN for going to a greater from a lesser facility?
No. Unless you are transporting the patient at a higher level of care than is warranted i.e. a non-emergent patient that could safely be transported by ground demands to be transported by air. Then you would need an ABN for the air transport.
REMEMBER: You only need an ABN when it is a non-emergent, Medicare covered transport where you believe all or part of the charges will be denied as not reasonable or necessary. You may choose to use an ABN in other non-emergent situations as a courtesy but it would not be required.
Do you have to use the Medicare approved ABN form?
Yes. Only the Medicare ABN form is acceptable and only minimal revisions are allowed. Most other forms can be developed by your service but this one is the exception. You can go the Medicare website at www.wpsmedicare.com and download the newest version in English and Spanish.
Can the patient sign with an X if necessary?
Yes. However, you and/or your partner would need to sign as a witness.
What about if patient has received narcotics? Can the patient still sign?
It depends on the level of consciousness of the patient. If they are no longer capable of signing due to narcotics causing decreased awareness then that would be a valid reason for the patient not to sign. However, if they are still alert and oriented then they may be perfectly capable of signing. Different people react differently to medications. You would need to assess their mental status before asking them to sign anything.
Can a phone call from the DPOA suffice on a consent form?
Only until you are able to obtain an actual signature or appropriate alternative. I would never delay care or transport to wait for a signature but before you submit the claim, I’d attempt to obtain an actual signature or appropriate alternative.
If you attach copies of the hospital records to the run report does that help or could it be used against you?
In most cases, the more information you have the better, especially in the case of appeals. Be aware however, that each run report MUST be able to stand on its own so you shouldn’t rely entirely on "attachments" to support things like medical necessity. Also, payers like Medicare are beginning to track diagnosis codes from beginning of transports to final disposition/discharge to verify consistency in billing and care.
How do we accurately reflect our times if we skew the date for loading the patient onto the unit/aircraft?
Transports that occur close to midnight can present a problem, but your run report should always reflect accurate times. If there is an error when you enter them then you can correct them via an addendum. For billing purposes the date of transport is the date & time when the wheels turn with the patient on board. Electronic patient care reports have the capability to enter a variety of times including the time dispatched, response, arrival and depart scene or referring facility. Just be sure your billing reflects the correct date and time.
Are the location/activity codes etc. required for every claim?
No. Only if they apply to the specific situation.
Does everything have to be included in the narrative or is putting it in the drop down boxes or PMHX good enough?
You do not need to re-type everything into the narrative. However, if it is something important, I would recommend you note it in the narrative. Be aware that Medicare tends to consider drop down boxes as containing statistical data while the narrative is considered to contain the medical necessity information.
For ALS Assessments etc. do we need to document who performed the assessment or is just listing that the ALS staff is on the call sufficient?
You need to document who actually performed the assessment, their certification level and he/she will need to sign the run report.
Does it have to be a paper signature or can it be an electronic signature?
Electronic signatures are acceptable.
What about Fixed Wing? We place an ECG monitor on all patients and there are two ALS personnel on board. How does that affect the ability to bill ALS?
Air transport, whether fixed wing or rotor wing is billed differently than ground. There is no ALS/BLS or Emergent/Non-emergent. All air is simply billed as Fixed Wing or Rotor Wing.

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