Wiki Ambulance coding

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rcartwright

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Elkvilke, IL
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I have a question regarding ambulance coding. If the ambulance is called because someone fell at home and can't get up and they get there and help the patient up but then they refuse to go to the hospital can we code and bill for this? It happens a lot and our ambulance service feels like they are just using them for lifting assistance. Any help or direction on how to code and bill this?
 
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Medicare says:

Although the HCPCS A0998 definition states "Ambulance response and treatment, no transport," this code has a Medicare Physician Fee Schedule (MPFS) status indicator of "I." Status "I" codes are not valid for Medicare reimbursement.

To receive a proper denial from Medicare to bill the patient when treatment nor a transport was provided, ambulance suppliers may:
  • Submit claim with unlisted HCPCS A0999; append GY modifier, and
  • Include comment "Patient refused transport" or "No transport" in Item 19 on CMS-1500 paper claim form or its electronic equivalent
  • Claim will deny "Patient Responsibility" (PR)

No Advance Beneficiary Notice od Noncoverage (ABN) is necessary

*****************************************************************************************************************************************

My local ambo gives a certain number of "freebies" then starts charging. I think they have a brochure they give to the patient each time it happens, with info about appropriate use of 911 and ambulance calls or something.
 
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fwnewbie said:
Ok so why have a code and definition if it's unusable or is it only Medicare that denies this code?
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According to my first google hit, Anthem Georgia says: In early 2018, Anthem became one of the first major insurers to reimburse EMS providers for appropriate and medically necessary care billed under HCPCS code A0998 (Ambulance response and treatment, no transport). The code, which has been active since January 2018 for most standard Anthem benefit plans, allows EMS providers to receive reimbursement for treatment rendered in response to an emergency call to a member’s home or scene, when transportation to the hospital emergency room (ER) was not provided. Previously, Anthem reimbursed EMS providers for treatment rendered only when a patient was transported to the ER.
 
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Good! The ambulance crews help elderly people and should be reimbursed something for their time/gas/expenses but I can see why Medicare is discouraging calls for just lifting help.
 
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