John Posted Thu 26th of April, 2018 19:49:48 PM
Patient is unable to transfer from bed because of full length cast. Patient must remain in horizontal position during transportation. She is transported from a rehab facility to a dialysis clinic and back by ambulance. What is the correct code for the ambulance service to be paid? The following statement is directly from the insurance company dealing with non emergency transportation: Ambulance Services - Non-Emergency
The Plan also covers transportation provided by licensed professional ambulance, (either ground or air ambulance, as UnitedHealthcare determines appropriate) between facilities when the transport is:
• From a non-Network Hospital to a Network Hospital;
• To a Hospital that provides a higher level of care that was not available at the original Hospital;
• To a more cost-effective acute care facility; or
• From an acute facility to a sub-acute setting.
SuperCoder Answered Fri 27th of April, 2018 08:12:01 AM
As per the documentation, report the ambulance service by HCPCS codes A0428 (Ambulance service, basic life support, non-emergency transport, (BLS)) AND A0425 (This code represents the ground mileage that an ambulance travels with a patient, per mile).
To report an ambulance service, you need to append a modifier denoting the start and end destination of the patient.
As per the provided documentation, the start place is rehab facility and the end destination is dialysis facility. There are multiple ambulance transportation modifiers available. Kindly append the appropriate modifier to the ambulance service code(s); or provide us with the below details:
- Where is the rehab facility based? Example: Physician office, Skilled nursing facility, other than physician or hospital.
- Is the dialysis facility hospital-based or non-hospital based dialysis facility?
- Also mention the mileage units. (from the pickup of a patient to his/her arrival at destination).
Note: Check with individual payer for coverage and reporting requirements.
John Posted Tue 01st of May, 2018 22:04:23 PM
Rehab facility is in skilled nursing home dialysis clinic is stand alone non hospital based
SuperCoder Answered Thu 03rd of May, 2018 06:33:42 AM
Thank you for providing us with the details.
Append the below modifiers to the HCPCS codes:
A0428- NJ (Ambulance Transportation from Skilled Nursing Facility to Non-hospital-based dialysis facility).
A0425- NJ (Ambulance Transportation from Skilled Nursing Facility to Non-hospital-based dialysis facility).
A0428- JN (Ambulance Transportation from Non-hospital-based dialysis facility to Skilled Nursing Facility).
A0425- JN (Ambulance Transportation from Non-hospital-based dialysis facility to Skilled Nursing Facility).
Note: A0425 (This code represents the ground mileage that an ambulance travels with a patient, per mile).