ED Coding and Reimbursement Alert

Question: Can I bill just the emergency medical technician (EMT) services? Where can I find this information?

Michigan Subscriber  
Answer: Information about Michigan's local Medicare carrier, Wisconsin Physicians' Services, can be found on the local medical review policy (LMRP) Web site at www.lmrp.net.
 
According to your local carrier, many services and supplies are considered to be part of general ambulance services and are included in the charge for the trip. The base charge for advanced life support (ALS) and basic life support (BLS) ambulance transportation includes charges for all personnel. It also includes charges for reusable supplies and capital equipment including driver, attendants, nurse in ambulance and an ALS director. Services also include CPR, defibrillation, monitoring of pulse oximeter, vital signs and EKG, IV and drug therapy, intubation and glucometer check, reusable supplies including antishock trousers, CPR board and nondisposable CPR mask, splints and C-collars. Capital equipment such as heart monitor, defibrillator, aspirator, backboard, pulse oximeter, IV pumps, stretchers, suction equipment, glucometer and compressors is also included.
 
The Wisconsin Physicians' Services statutes define BLS and ALS as follows:
 
1. BLS is emergency medical care that is rendered to a sick, disabled or injured individual, based on signs, symptoms or complaints, prior to the individual's hospitalization or while transporting the individual between healthcare facilities. It is limited to use of the knowledge, skills and techniques received from training required for licensure as an EMT.
 
2. ALS is the use by appropriately trained and licensed personnel in prehospital and interfacility emergency care and transportation of patients of the medical knowledge, skills and techniques included in the department. Approved training is required for licensure of EMTs -- intermediate or paramedic -- and are not included in BLS.
 
Billing must always reflect the level of service required by the patient and the actual service provided based on the provider's licensure. The CPT codes may be used in the following ways:  
  
1. Use A0429 for BLS transport services.
  
2. Use A0427 when an ALS service is provided.
  
3. To report loaded miles (depending on level of service provided) use:
    
A0425 for loaded miles for BLS transports.
    
A0425 for loaded miles for ALS transports.  
To bill for supplies use:
 
A0382 for BLS transports.
 
A0398 for ALS transports.
 
When submitting a claim for an ALS service, list the names of crew on board, and the hospital and doctor the crew is in contact with.
 
Documentation in the progress notes must reflect medical necessity and be available on request.  
-- Answers to You Be the Coder and Reader Questions were provided by Kia R. Earp, CCS, coding specialist for health information services at Brigham and Women's Hospital in Boston.