It is well known that Modifiers cover a broad scope of information. Although, the ICD-10 codes correspond to parts of the body, yet there are also modifiers for ambulance services and mammograms. These modifiers have been provided so as to indicate that the service or procedure has been altered by some specific circumstance, but has not been changed in definition or code.
However, here we will be focusing on the Healthcare Common Procedure Coding System (HCPCS), also nicknamed 'hicks-picks" modifiers that directly affects reimbursement with respect to Ambulance Billing and coding. HCPCS modifiers also allow for greater accuracy in coding and can be extremely important in the reimbursement process, making for a more effective Revenue Cycle Management (RCM) process.
|Diagnostic or therapeutic site other than "P" or "H"
|The residential, domiciliary, custodial facility, nursing home other than SNF (other than 1819 facility)
Hospital-based dialysis facility (hospital or hospital-related) which includes:
|The site of transfer (e.g., airport, ferry, or helicopter pad) between modes of ambulance transport
Non-hospital-based dialysis facility
|Skilled Nursing Facility (SNF) (1819 Facility)
|Physician's Office (includes HMO non-hospital facility, clinic, etc.)
|The scene of Accident or Acute Event
|Destination Code Only) Intermediate stop at physician's office en route to the hospital (includes HMO non-hospital facility, clinic, etc.)
|Use when billing for statutorily excluded services. Example - Patient transport is for a non-covered condition that does not meet the definition of any Medicare benefit. The provider is expecting a denial.
|Use when the patient is pronounced deceased after the ambulance is called. The patient is pronounced dead after the ambulance is called but before transport. Ground providers can bill a BLS service along with the QL modifier. Air providers can use the appropriate air base rate code (fixed wing or rotary wing) with the QL modifier. There will be no rural allowance or mileage billed.
|When more than one patient is transported in an ambulance and document details of the transport. Used by both ground and air transports.
|The provider or supplier has provided an Advance Beneficiary Notice (ABN) to the patient.
|The provider or supplier expects a medical necessity denial; however, did not provide an Advance Beneficiary Notice (ABN) to the patient. There are only four situations where the Limitation of Liability provision applies to ambulance suppliers. In those situations, a CMS-approved Advance Beneficiary Notice form is needed by an ambulance company to reverse the limitation of liability.
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Proper usage of the above HCPCS codes in ambulance billing and coding, along with meticulous documentation, will help in the reimbursement process and lower denial claims which affect the Revenue Cycle Management process.