5010 Requirements for Ambulance Suppliers

If you are an ambulance supplier who plans an early adoption of version 5010 of the 837P electronic claim format, be aware that effective for claims submitted to Medicare on or after Jan. 1, 2011, you’ll have three options for complying with the new diagnosis reporting requirement.

According to MLN Matters SE1029:

Option 1: Suppliers may choose codes from the Medical Conditions List provided by the Centers for Medicare & Medicaid Services (CMS) that corresponds to the condition of the beneficiary at the time of pickup and report the codes in the diagnosis field on the claim. The codes in the Medical Conditions List are taken from the ICD-9-CM diagnosis code set. Suppliers must continue to accurately maintain transport records to support any data reported on the claim.

Option 2: Suppliers may report an ICD-9-CM (or ICD-10-CM when appropriate) diagnosis code that is provided to them by the treating physician or other practitioner.

Option 3: Suppliers may report ICD-9-CM diagnosis code 799.9 Unspecified illness.

Alternatively, you can continue to use the 4010A1 version of the 837P until Dec. 31, 2011. After that, however, version 5010 and its diagnosis reporting requirements are mandatory.

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