Friday, October 22, 2010

important electronic field of ambulance billing

DOCUMENTATION

When submitting a claim to NHIC for payment, or appeals, it is essential that providers supply claims information that will substantiate (1) the patient’s need to be transported by ambulance, versus other forms of transportation, and (2) the level of service utilized. The provider can make use of the following field(s) to communicate this information:

• ICD-9-CM codes, or a written description of the patient’s condition at the time of transport (See Medical Condition List in Appendix A)

• CMS 1491 – item 22
• CMS 1500 – item 21

o Electronically
 Written description in narrative fields
 ICD-9 CM codes fields (H101-2, H102-2, H103-2, H104-2)
• Narrative fields (NTE02, CR109 and/or CR110)
• Transportation Indicators (enter in narrative field NTE02) (voluntary)
• Condition Indicators (CRC03 – CRC07) (voluntary)
• Type of Transport Indicator (CR103)
• Reason for Transport Indicator (CR104)
• Attachments to a paper claim (for appeals)

In order to determine the medical appropriateness of air ambulance services the carrier may request that documentation be submitted that indicates the air ambulance services are reasonable and necessary to treat the beneficiary’s life-threatening condition.

In all cases, the appropriate documentation must be kept on file and, upon request, presented to the carrier. It is important to note that neither the presence nor absence of a signed physician’s order for an ambulance transport necessarily proves (or disproves) whether the transport was medically necessary. The ambulance service must meet all program coverage criteria in order for payment to be made.

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