part 2 - codingambulance services throughout the nation. steve served as founding executive director...

PART 2 - CODING

Presented by

Doug Wolfberg, Esq., CAC, CACO, CAPO Steve Johnson, CAC, CACO, CAPO

www.pwwemslaw.com

5010 E. Trindle Road, Suite 202 Mechanicsburg, PA 17050

717-691-0100 717-691-1226 (fax)

[email protected] [email protected]

© COPYRIGHT 2015, PAGE, WOLFBERG & WIRTH, LLC. ALL RIGHTS RESERVED. REPRODUCTION BY ANY MEANS EXPRESSLY PROHIBITED WITHOUT

THE WRITTEN CONSENT OF PAGE, WOLFBERG & WIRTH, LLC.

ICD-10 FOR THE

AMBULANCE INDUSTRY

mailto:[email protected]

mailto:[email protected]

2015

Page, Wolfberg & Wirth, LLC ● 5010 E. Trindle Rd., Ste. 202 ● Mechanicsburg, PA 17050

www.pwwemslaw.com ● 717-691-0100 ● Fax – 717-691-1226

Douglas M. Wolfberg, Partner [email protected]

Doug Wolfberg is a founding partner of Page, Wolfberg & Wirth, and one of the best known EMS attorneys and consultants in the United States. Widely regarded as the nation’s leading EMS law firm, PWW represents private, public and non-profit EMS organizations, as well as billing companies, software manufacturers and others that serve the nation’s ambulance industry. Doug answered his first ambulance call in 1978 and has been involved in EMS ever since. Doug became an EMT at age 16, and worked as an EMS provider in numerous volunteer and paid systems over the decades. Doug also served as an EMS educator and instructor for many years.

After earning his undergraduate degree in Health Planning and Administration from the Pennsylvania State University in 1987, Doug went to work as a county EMS director. He then became the director of a three-county regional EMS agency based in Williamsport, Pennsylvania. He then moved on to work for several years on the staff of the state EMS council. In 1993, Doug went to the nation’s capital to work at the United States Department of Health and Human Services, where he worked on federal EMS and trauma care issues. Doug left HHS to attend law school, and in 1996 graduated magna cum laude from the Widener University School of Law. After practicing for several years as a litigator and healthcare attorney in a large Philadelphia-based law firm, Doug co-founded PWW in 2000 along with Steve Wirth and the late James O. Page. As an attorney, Doug is a member of the Pennsylvania and New York bars, and is admitted to practice before the United States Supreme Court as well as numerous Federal and state courts. He also teaches EMS law at the University of Pittsburgh, and teaches health law at the Widener University School of Law, where he is also a member of the school’s Board of Overseers.

Doug is a known as an engaging and humorous public speaker at EMS conferences throughout the United States. He is also a prolific author, having written books, articles and columns in many of the industry’s leading publications, and has been interviewed by national media outlets including National Public Radio and the Wall Street Journal on EMS issues. Doug is a Certified Ambulance Coder (CAC) and a founder of the National Academy of Ambulance Coding (NAAC). Doug also served as a Commissioner of the Commission on Accreditation of Ambulance Services (CAAS).

http://www.pwwemslaw.com/

2015

Page, Wolfberg & Wirth, LLC ● 5010 E. Trindle Rd., Ste. 202 ● Mechanicsburg, PA 17050

www.pwwemslaw.com ● 717-691-0100 ● Fax – 717-691-1226

Steven M. Johnson, Director of Reimbursement Consulting [email protected] Steve began his career in the EMS industry in 1985, gaining valuable experience while serving as an EMT and later as Director of a municipal ambulance service in Minnesota. As an ambulance service manager, Steve established his expertise in areas of operations, billing and administration.

Steve also has significant EMS educational experience. He established and served as Training Coordinator and Lead Instructor for a State Certified EMS Training Institution for EMTs and First Responders.

Steve served on both the Rules Work Group and the EMS Advisory Council to the Minnesota State Department of Health.

He joined the staff of a large, national billing and software company, where he was a frequent lecturer at national events and software user group programs. For over seven years, Steve served as Director of a national ambulance billing service and was responsible for all aspects of managing this company, including reimbursement, compliance and other activities for ambulance services throughout the nation.

Steve served as founding Executive Director of the National Academy of Ambulance Coding (NAAC), overseeing all activities of the Academy, including the Certified Ambulance Coder program, the nation’s only coding certification program specifically for ambulance billers and coders.

As the Director of Reimbursement Consulting with Page, Wolfberg & Wirth, Steve is involved in all facets of the firm’s consulting practice. Steve works extensively on billing and reimbursement-related activities, performing billing audits and reviews, improving billing and collections processes, providing billing and coding training, conducting documentation training programs, and performing many other services for the firm’s clients across the United States.

Steve is also a licensed private pilot, and enjoys an active role in his church.

http://www.pwwemslaw.com/

IMPORTANT NOTICE FOR SEMINAR ATTENDEES The information presented in this seminar and these supporting materials does not constitute legal advice or a definitive statement of the law. These materials are for educational purposes only and to provide a general overview of the issues discussed. The information contained in these materials and discussed at this seminar are subject to change at any time by new laws or regulations, repeals or modifications of existing laws and regulations, court and agency decisions, and in numerous other ways. While our materials are, whenever possible, based on official sources of information from Medicare and other government agencies, you must consult the official sources of materials from those agencies – including regulations, manuals, policies, advisory opinions, etc. – for official statements of the law and government policy. Of course, we cannot be responsible to update these materials for you, nor are we responsible for any documentation, billing, compliance, reimbursement, legal or other decisions you make based in whole or in part upon these materials. We use examples of documentation, billing scenarios and other teaching illustrations throughout this seminar, and they are just that – examples. Do not use any wording in your own documentation unless it is truthful and accurate. While we believe the information presented in this seminar and in these materials to be accurate, errors (such as typographical or other content errors) are possible. Ensure that your agency’s legal counsel is aware of any specific legal issues you may have. All materials are the Copyright of Page, Wolfberg & Wirth, LLC unless otherwise noted. No part of this material may be duplicated, reproduced or distributed by any means. No audio, video and/or digital recording of any type is permitted at this conference. By attending this seminar, and/or utilizing these materials, you agree to these terms and conditions.

© Copyright 2015 PWW Media, Inc.

Page 1Purchase the New ICD-10 Ready abc QuikGuide at www.pwwemslaw.com

ICD-10 for the Ambulance IndustryPart 2 of 3: Coding

May 13, 2015© Copyright 2015 PWW Media


Join Us Again Next Week!ICD-10 for the Ambulance industry

Part 3

Documentation

May 20, 2015

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New Features:

-Ambulance ICD-10 Codes-Common EMS abbreviations-Medicare appeals info-Revalidation tips-MAC-specific info

And all ambulance codes, modifiers, definitions and

billing tips!

All New

abcQuikGuideNow Available!

WARNINGThe unauthorized reproduction or

distribution of this copyrighted work is illegal. Criminal copyright infringement, including infringement without monetary gain, is investigated by the FBI, and is punishable by up to 5 years in federal

prison and a fine of $250,000.

DISCLAIMERS

This information is presented for educational and general information purposes and should not be

relied upon as legal advice or definitive statements of the law. Consult applicable laws, regulations and policies for officials statements of the law.No attorney-client relationship is formed by the use of these materials or the participation in this seminar. The user of these materials bears the responsibility for compliance with all applicable

laws and regulations.

AUDIO OR VIDEO RECORDING OF THIS WEBINAR IS

STRICTLY PROHIBITED

This Webinar Series is: Three NAAC® Certifications




Questions

Submit your questions anytime during today’s webinar

Use the “Question and Answer” feature on your GoToWebinar®

control panel Or, fax them to (717) 691-1226


Today’s Webinar

Updates and Reminders Implementation Tools Interpreting Clinical Documentation ICD-9 vs. ICD-10 Coding Examples Planning Your Implementation

Updates and Reminders


Medical Conditions List

Transmittal 3240 (CR 9142) dated April 24, 2015• The ICD-9-CM Medical Conditions List

and transportation indicators list in Chapter 15, section 40 of the Claims Processing Manual has been moved to the CMS Web site.

• “There are no policy changes as a result of moving this information to the CMS website.”


Medical Conditions List

http://www.cms.gov/Center/Provider-Type/Ambulances-Services-Center.html

Two pdf files lower right corner of the page under “Other Guidance”• First pdf contains the Condition Codes• Second pdf - Transportation Indicators


What Will Become of the “Condition Codes”?

The list of ambulance condition codes issued by CMS was based on ICD-9 codes

The ICD-9 codes on the condition code list can not be used for dates of service on or after October 1, 2015

CMS has said it will not be issuing a new condition codes list for ICD-10




What Will Become of the “Condition Codes?”

Unless your MAC issues an LCD with required ICD-10 codes, you will be free to use any ICD-10 codes

The condition code list is still a good list of ambulance-specific conditions frequently encountered by EMS providers


What Will Become of the “Condition Codes?”

PWW and others have used the condition code list as a template for a workable ICD-10 code list

Use this time to develop your own manageable list of commonly-applicable, ambulance-specific ICD-10 codes• The CMS ambulance condition codes can

be a good starting point


What Will Become of the “Condition Codes”

The “Transportation Indicators” (C1, C2, etc.) are not ICD-based

Check with your MAC to see if those will be considered on Medicare claims going forward


ICD-9 or ICD-10?Based on Date of Service

Systems will need to properly process claims with both ICD-9 and ICD-10 for at least a year• Timely filing deadline• MSP claims/third party liability• Appeals• External Audits

Tools to Assist With Your Implementation

Both of these important tools, developed by PWW, are included as part of this

Webinar!


Implementation Tool #1

PWW Condition Code to ICD-10 Crosswalk• This list gives you a great jumpstart to

think about the codes most commonly used by ambulance services

• You may want to compare these current ICD-9 codes to those most commonly used in your specific service to build your own crosswalk




Implementation Tool #2

PWW ICD-10 Readiness Billing and Coding Worksheet

Use this worksheet for your internal ICD-10 training and coder evaluation processes, as you make your preparations for the transition to ICD-10

Interpreting Clinical Documentation



First of all clinical documentation (i.e. crew PCRs) must be accurate, complete, comprehensive, and legible!• This will be covered in detail in Part 3

Then, do billers and coders “understand their language”?



Acronyms and abbreviations While the importance of a good

thorough narrative cannot be overstated, do billers and coders also know how to draw proper clinical conclusions, that are supported by the medical record from other sections of the PCR?



For example, do billers and coders understand how to interpret clinical findings from documented vitals?

What are “normal limits”?• Tachycardia• Tachypnea• Hypertension



It is important that your billers and coders carefully evaluate the entire medical record in selecting appropriate ICD codes and not simply “cherry pick” specific words or phrases out of the narrative





Don’t allow “assumption coding” Code only to the level of specificity

supported by the documentation



If the documentation does not provide enough information to properly code the claim, obtain the necessary information to make accurate and supportable coding decisions


Addendums to Documentation

If the record is not complete, it is absolutely appropriate to request that it be completed

Any addendum to a PCR should be completed by the crew member who completed the original clinical documentation


Documentation Addenda

When requesting an addendum make sure that the focus is always on Clinical Documentation Improvement(CDI) and the importance of having a complete medical record


Documentation Addenda

Ensure that the requests are not “suggestive”

Requests should not be attempts to obtain some predetermined, desired result for coding or billing the claim


Addendums to Documentation

Using a “CDI Query Form” can help to ensure a consistent message, with a focus on improving the quality of the clinical documentation, and to advocate complete and compliant documentation

More on the CDI Query process (and a model Form) in Part 3 of the ICD-10 webinar series



ICD-9 vs. ICD-10

Exploring the Differences


What Are The Main Differences?

Laterality Specificity “X” Placeholders Number of Codes Increased 2 Types of “Excludes Notes” Length of Codes Increased


Laterality

More than 40% of new codes specify right, left, or bilateral

In most cases this should be something that your crews have been documenting already, but ICD-9 didn’t always have a way to report it


Specificity

While some ICD-9 codes convert directly to one ICD-10 code, others allow for a great deal more specificity in ICD-10• 786.50 “Chest pain unspecified”

converts directly to R07.9• 989.5 “toxic effect of venom” “converts

approximately” to nearly 200 ICD-10 codes


Specificity

In ICD-10-CM approximately 50% of all codes are related to the musculoskeletal system

Approximately 25% are related to fractures


Example of ICD-10 Specificity

S52 Fracture of forearm• S52.5 Fracture of lower end of radius• S52.52 Torus fracture of lower end of

radius• S52.521 Torus fracture of lower end

of right radius• S52.521A Torus fracture of lower end

of right radius, initial encounter for closed fracture




ICD-10 Example

Only one of the codes on the previous slide is a “billable code”• S52.521A Torus fracture of lower end of

right radius, initial encounter for closed fracture


ICD-10 Example

There are 2,796 “billable” ICD-10 codes beginning with S52 (Fracture of forearm)

But Wait . . .

Before you decide you’ll never be able to properly code

another claim . . .


More Likely EMS Example

S52 Fracture of forearm• S52.9 Unspecified fracture of forearm

• S52.91 Unspecified fracture of right forearm

• S52.91XA Unspecified fracture of right forearm, initial encounter for closed fracture


ICD-10 Example

Here again, only one of the codes on the previous slide is a “billable code”• S52.91XA Unspecified fracture of right

forearm, initial encounter for closed fracture

BUT – documentation to this level of specificity (closed fracture of right forearm) is reasonable to expect in an EMS setting


CMS On Unspecified Codes

Despite the emphasis on specificity, codes that indicate an unspecified or other diagnosis are sometimes appropriate and should be used when:





• A more specific diagnosis has not been documented in the medical record and they are the codes that most accurately reflect what is known about the patient's condition at the time of that particular encounter



• Forcing coders to use a specified code may result in the unintended consequence of creating misinformation that assumes something is true when there is no real evidence to support that level of specificity



• In some instances signs and symptoms or unspecified codes are the best choice to accurately reflect the healthcare encounter



Each healthcare encounter should be coded to the level of certainty known for that encounter

If a definitive diagnosis is not established by the end of the encounter it is appropriate to report codes for signs and/or symptoms in lieu of a definitive diagnosis


“X” Placeholders

Allow for further expansion Maintain a specific purpose /

interpretation of certain specific characters• For example Character 7 can have the

same meaning whether the rest of the code is 3, 4, 5 or 6 characters T68.XXXA – Hypothermia, Initial Encounter


Number of Codes Increased

Approximately 14,000 ICD-9 Codes Approximately 69,000 ICD-10 Codes However, keep in mind that only a

very limited subset of these 69,000 codes is most relevant to patient care in EMS, and the transports your particular ambulance service may provide




2 types of “Excludes Notes”

An Excludes1 denotes "not coded here," meaning coders should never report the excluded code at the same time as the code above the Excludes1 note (e.g., the congenital form versus an acquired form of the same condition)


2 types of “Excludes Notes”

An Excludes2 denotes "not included here," meaning that the condition excluded is not part of the condition represented by the code even though a patient may have both conditions at the same time.

When an Excludes2 note appears under a code, coders can report both codes together, when appropriate


Length of Codes Increased

ICD-9 codes are 3 - 5 characters ICD-10 codes are 3 - 7 alpha-

numeric characters• Character 1 is always alpha• Character 2 is always numeric• Characters 3 – 7 are either alpha or

numeric• The decimal is placed after the 3rd

character© Copyright 2015 PWW Media, Inc.

ICD-10 Taxonomy

Characters 1-3 = Category Characters 4-6 = Etiology, Anatomic

Site, Severity, other vital details Character 7 = Extension (Primarily

used for episode of care)


Example – T78.40XA

Allergy, Unspecified, Initial Encounter


ICD-10 Code Organization

Character 1 Examples• K = Diseases of the digestive system• M = Diseases of musculoskeletal system• O = Pregnancy, childbirth• R = Symptoms, signs and abnormal

clinical and laboratory findings, not elsewhere classified

• S or T = Injury, poisoning and certain other consequences of external causes




Other Differences

Injuries are grouped by anatomic site instead of by type of injury

“V” and “E” codes are now incorporated into the main classification, rather than separated into supplementary classifications


What Are The Benefits?

These changes support flexibility and expandability Clinical – Increased public health

reporting and long-term tracking of illnesses



Operational – Enhances definition of patient conditions, facilitating improved matching of resources and care teams with the needs of the patient



Professional – Provides clear, objective data which can help improve billing decisions, thereby helping to prevent fraud and abuse

Coding Examples


Scenario 1

85-year-old male sustained a crush injury to his left femur from a forklift accident while he was a consumer in a building store. The forklift hit his leg and crushed it. The patient sustained an open fracture of his left middle femur shaft. There was a 2-to-3 inch skin avulsion and moderate surrounding tissue damage to his left lateral thigh approximately 5 inches superior to the knee.




Scenario 1

ICD-9 – 821.11 - open fracture of the shaft of the femur

ICD-10 – S72.302B© Copyright 2015 PWW Media, Inc.

Scenario 1

Other Possible ICD-10 Codes (if payer requires “external cause of injury” codes be reported for injury)• W23.0XXA• V83.7XXA


S1 External Cause of Injury

W23.0XXA – Caught, crushed, jammed, or pinched between moving objects, initial encounter


S1 External Cause of Injury

V83.7XXA – Person on outside of special industrial vehicle injured in nontraffic accident, initial encounter


Scenario 1 – Condition Codes

ICD-9 – 829.0 – Other Trauma –Suspected fracture

ICD-10 – T14.8© Copyright 2015 PWW Media, Inc.

Scenario 2

70-year-old female patient with complaint of chest pain that awoke her from sleep. Patient describes the pain as mid-sternal "tight, squeezing" and pressure in the epigastric region. Patient rates pain 8 of 10. Patient states she tried sitting up, walking, and taking some liquid antacid but experienced no relief with these measures. Denies change in diet, or any unusual foods yesterday. Patient has a history of hypertension for which she takes HCTZ. Current vitals: P 90, R 16, BP 210/106.




Scenario 2

ICD-9 – 786.50 – Chest Pain, unspecified

ICD-10 – R07.9 - Chest pain, unspecified© Copyright 2015 PWW Media, Inc.

Scenario 2

Additional possible ICD-10 codes:• I10 - Essential (primary) hypertension


Scenario 3

83-year-old male being returned to SNF from hospital where he was seen for severe respiratory distress. Patient is bed confined following CVA 2 years ago. Patient is unable to ambulate unable to sit in a chair or wheelchair and unable to get out of bed. Patient is on 02 at 4 LPM, and is unable to self regulate.


Scenario 3

ICD-9/Condition Code – 492.8 –Third party assistance/attendant required to apply, administer, or regulate or adjust oxygen en route


Scenario 3

ICD-10 – Z99.81 - Dependence on supplemental oxygen


Scenario 3

ICD-10 – Z74.01 – Bed confinement status




Scenario 4

27-year-old male being transported from hospital to psych unit after receiving medical clearance. Restraints required due to patient being a flight risk. Patient transported with four-point restraints. Vitals remained within normal limits throughout transport.


Scenario 4

ICD-9/Condition Code – 298.9 –Patient safety: Danger to self or others – in restraints


Scenario 4

ICD-10 – Z78.1 – Physical restraint status Planning Your

Implementation


Preparation For Implementation

Start by analyzing current claims• Dispatch Documentation• Crew Documentation• Patient Mobility Reports• Levels of Service• Frequently Used ICD-9 Codes



Train your billers and coders in the use of ICD-10 codes

Select test claims for billers and coders to use for practice coding

Determine and test internal systems and workflow processes you intend to use for your claims using ICD-10 codes





Practice coding in ICD-10 and validate that the resulting claims would be adequately supported by the documentation, using the PWW ICD-10 Readiness Worksheet• This will help you to determine whether

the documentation you are currently receiving will be sufficient with the transition to ICD-10 codes



Conduct “Internal Coding Clinics”• Evaluate individual answers to the

sample claims used with the PWW ICD-10 Readiness Worksheet

• Identify areas of potential coding challenges in your operation

• Determine solutions to those challenges• Provide solutions to all affected staff (in

all affected departments)



Conduct external testing with vendors and payers using data that contain ICD-10 codes


Two Types of Testing With MAC

Acknowledgement Testing• Submitting claims with ICD-10 codes

and receiving electronic acknowledgements confirming that the claims were accepted

End-to-End Testing• Focused process to measure operational

predictability and readiness in an environment which mirrors actual production as closely as possible


Acknowledgement Testing

Upcoming ICD-10 Acknowledgement Testing week: June 1 – June 5, 2015

Uses “current dates of service” Will receive a 999 Acknowledgement Will not confirm payment or produce

a remittance advice Contact MAC for more information


Acknowledgement Testing

Important tips for sending a test file: The ISA15 must equal “T” The file must contain 25 claims The file should contain a variety of

the types of claims submitted on a normal basis

The qualifiers for ICD.10 should be reported as ABK or ABF in the 2300 HI segment




End-to-End Testing

Upcoming End-to-End Testing week – July 20 – July 24, 2015

Limited number of selected volunteers

MLN Connects Newsletter dated Thursday, May 7 stated, “CMS is accepting additional July volunteers from May 11 through 22, 2015.”


End-to-End Testing

Will produce an electronic remittance advice

Contact MAC for more information Uses “FUTURE dates of service”

• WARNING! – Check with your software vendors before considering changing your “System Clock” for any “future date testing”



Research any ICD-10 related LCDs from any MAC to which you will be submitting claims


Example: Novitas LCD

Note: this information was taken from the Novitas “Future LCD” released in April 2014

It may change – or may not even be implemented - prior to ICD-10 implementation in October 2015

Stay tuned with your MAC!


Example Novitas LCD

All ambulance transports require dual diagnosis codes• Providers should report the most

appropriate ICD-10 code that adequately describes the patient’s medical condition (for example; stroke, coma, trauma, etc.) at the time of transport as the primary diagnosis. In addition, a secondary diagnosis, from the following list must be reported.


Example Novitas LCD

Code Description• Z74.01 Bed confinement status• Z74.3* Need for continuous supervision• Z78.1* Physical restraint status• Z99.89* Dependence on other enabling

machines and devices




Example Novitas LCD

Additionally, the KX Modifier must be reported on the claim for the service to be considered for coverage


Novitas – KX Modifier

“Reporting of the KX modifier is an attestation from the provider that the services are reasonable and necessary and that there is documentation of medical necessity in the patient's record.”


Novitas – KX Modifier

“The KX modifier should not be reported if the patient’s condition does not require an ambulance for transport or the services of the ambulance crew as described in the condition tables.”


KX Modifier Question

If there is now a “Third Modifier” necessary on some claims, do you know where that needs to be entered in your system to be properly reported on medically necessary claims?

Check with your billing software vendor if you do not!


Implementation Suggestion

Consider a carefully controlled claim submission approach to test, especially to high volume payers, upon implementation

Closely monitor claim submission reports

Follow-Up




Payments

Closely monitor Remittance Advices upon implementation

Remember, time of payment posting is perhaps your last great opportunity to review your claims to ensure they were properly processed and adjudicated


Resources

roadto10.org - online tool for small providers transitioning to ICD-10• Action plans • Common codes used • Primer for documentation

icd10data.com – online ICD-10 lookup, and tool for conversion from ICD-9 to ICD-10

New Features:

-Ambulance ICD-10 Codes-Common EMS abbreviations-Medicare appeals info-Revalidation tips-MAC-specific info

And all ambulance codes, modifiers, definitions and

billing tips!

All New

abcQuikGuideNow Available!


Questions Submit your

questions. Use the “Question

and Answer” feature on your GoToWebinar control panel.

Or, fax them to (717) 691-1226.


Need Help? Contact PWW! Sign up for our free EMS Law Bulletins at

www.pwwemslaw.com


Ambulance Condition Code ICD‐10 Conversion Chart – Version 2.1 Terms and Conditions of Use

Read this important notice carefully. Do not use this Chart if you don’t agree to these terms.

If you use this Chart, you agree to these terms.

The Ambulance Condition Code ICD‐10 Conversion Chart (the “Chart”) was produced by Page, Wolfberg & Wirth, LLC (PWW) in order to assist ambulance services in the transition from ICD‐9 to ICD‐10 codes. The Chart is not an official government document. The Chart is based on the definitions contained in the Ambulance Medical Conditions List published by the Centers for Medicare and Medicaid Services (Transmittal 1185, CR 5442, February 23, 2007). The ICD‐9 codes associated with the CMS Ambulance Medical Conditions List were converted to ICD‐10‐CM codes utilizing a combination of electronic and manual conversions, as noted on the Chart. Electronic conversions were completed utilizing the publicly‐available software found at www.icd10data.com. Manual conversions were utilized: (1) where electronic conversions resulted in an excessive number of possible ICD‐10 codes; (2) electronic conversions were illogical based on the definitions approved by CMS in the Ambulance Medical Conditions List; and (3) instances where the Ambulance Medical Conditions List definitions differed substantially from the actual ICD‐9‐CM code definitions and manual conversions were utilized to supplement the electronic conversions.

The user is solely responsible for all coding decisions on all claims it prepares and/or files with Medicare, Medicaid or any other public or private payer or insurer. All claims must be coded in accordance with the patient’s condition as accurately documented on the patient care report and other documentation. The user must adhere to any list of approved codes issued by any applicable state or federal government agency, and/or Medicare Administrative Contractor (MAC). Users are instructed that they are not limited in their coding to the ICD‐10 codes contained on this Chart, that there may be multiple appropriate codes for specific claims, and there may be ICD‐10 codes that are more appropriate or specific for their claims than the ones contained on this Chart.

PWW makes no guarantee or representation of any type regarding whether or not the use of this Chart will result in the payment or denial of any claims. All claims must strictly comport with all applicable laws, regulations, rules and guidelines of the payer to which the claim is submitted, and compliance with these laws, regulations, rules and guidelines is solely the responsibility of the user.

This Chart is a working draft and is subject to periodic updates and revisions. PWW cannot be responsible to automatically provide updates to any user. The user, by its use of the Chart, expressly agrees to these Terms and Conditions, and releases PWW and its partners, employees, agents and consultants, from any and all liability or damages of any kind arising in any manner from the use of the Chart.

IMPORTANT NOTICE FOR WEBINAR ATTENDEES

The information presented in this webinar and these supporting materials does not constitute legal advice or a definitive statement of the law. These materials are for educational purposes only and to provide a general overview of the issues discussed. Attending this webinar is only one part of a formal, comprehensive corporate compliance program, which we urge all ambulance services to implement.

The information contained in these materials and discussed during this webinar are subject to change at any time by new laws or regulations, repeals or modifications of existing laws and regulations, court and agency decisions, and in numerous other ways. While our materials are based on official sources of information from Medicare, OIG and other government agencies, you must consult the official sources of materials from those agencies – including regulations, manuals, policies, advisory opinions, etc. – for official statements of the law and government policy. Of course, we cannot be responsible to update these materials for you, nor are we responsible for any billing, compliance, reimbursement, legal or other decisions you make based in whole or in part upon these materials.

We use examples of documentation, coding scenarios and other teaching illustrations throughout this webinar, and they are just that – examples. Do not use any wording in your own documentation unless it is truthful and accurate.

While we believe the information presented in this webinar and in these materials to be accurate, errors (such as typographical or other content errors) are possible. Consult your legal counsel for advice on dealing with any specific legal issues you may have.

Webinar materials are the Copyright of PWW Media, Inc. unless otherwise noted. No part of this material may be duplicated, reproduced or distributed by any means. No audio, video and/or digital recording of any type is permitted of this webinar.

By attending this webinar, and/or utilizing these materials, you agree to these terms and conditions.

Ambulance Condition Code ICD‐10 Conversion Chart Version 2.1ICD‐9 Con

ditio

n Co

de ICD‐9 Condition Code

DefinitionICD‐9 Condition Code Examples ICD‐9 Code Definition

Possible

ICD‐10 Co

de(s)

ICD‐10 Code Definition

K29.70

K29.90

Gastritis, unspecified, without bleeding

Gastroduodenitis, unspecified, without bleeding

R10.9 Unspecified abdominal pain

427.9

Abnormal Cardiac rhythm/cardiac dysrhythmia

Potentially life‐threatening

Bradycardia, junctional and ventricular blocks,non‐sinus tachycardias, PVC’s >6, bi and trigeminy, ventricular tachycardia, ventricular fibrillation, atrial flutter, PEA, asystole, AICD/AED Fired Cardiac dysrhythmia I49.9 Cardiac arrhythmia, unspecifed

R61 Generalized hyperhidrosis

R23.8 Other skin changes

796.4 Abnormal vital signs With or without symptomsOther abnormal clinical findings R68.89 Other general symptoms and signs

T78.2XXA Anaphylactic shock, unspecified, initial encounter

T78.40XA Allergy, unspecified, initial encounter

R73.01 Impaired fasting glucose

R73.09 Other abnormal blood glucose

535.50 Severe abdominal pain

With other signs or symptoms

Nausea,vomiting,fainting, pulsatile mass, distention, rigid, tenderness on exam, guarding.

Unspecified gastritis and gastroduodenitis, without mention of hemorrhage

995.0 Allergic reaction

y g

Other emergency conditions, rapid progression of symptoms, prior hx. Anaphylaxis

Emergency Condition Codes ‐ ALS (Non trauma)

780.8 Abnormal skin signs Diaphorhesis, cyanosis, delayed cap refill, poor turgor, mottled. Generalized hyperhidrosis

790.21 Blood glucose

Abnormal <80 or >250, with symptoms

Altered mental status, vomiting,signs of dehydration Impaired fasting glucose

Page 1 of 17 Prepared by Page, Wolfberg & Wirth, LLC. ‐ May 2015This is an educational tool only and does not constitute legal advice.

User bears all responsibility for use and for compliance with all applicable laws and regulations.


ditio

n Co



Possible

ICD‐10 Co

de(s)


799.1 Respiratory arrest

Apnea, hypoventilation requiring ventilatory assistance and airway management. Respiratory arrest R09.2 Respiratory arrest

786.05 Difficulty breathing Shortness of Breath R06.02 Shortness of Breath427.5 Cardiac arrest Cardiac arrest I46.9 Cardiac arrest, cause unspecified

786.50 Chest pain

Dull, severe, crushing, substernal, epigastric, left sided chest pain associated with pain of the jaw, left arm, neck, back, and nausea, vomiting, palpitations, pallor, diaphoresis, decreased LOC. Chest pain, unspecified R07.9 Chest pain, unspecified

784.99 Choking episodeAirway obstructed or partially obstructed

Other symptoms involving head and neck

T17.200A Unspecified foreign body in pharynx causing asphyxiation, initial encounter

991.6Cold exposure life/limb threatening

Potentially life or limb threatening

Temperature < 95F, deep frost bite, other emergency conditions Hypothermia T68.XXXA Hypothermia, initial encounter

R41.82 Altered Mental Status, unspecifiedR40.241

R40.242

R40.243

Glasgow coma scale score 13‐15



780.39 Convulsions/Seizures

Seizing, immediate post‐seizure, postictal, or at risk of seizure and requires medical monitoring/observation. Other convulsions R56.9 Unspecified convulsions

780.97 Altered LOC Acute condition with Glascow Coma Scale < 15. Altered Mental Status




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I67.9 Cerebrovascular disease, unspecified

G44.89 Other headache syndrome

785.1 Cardiac symptoms Palpitations, skipped beats Palpitations R00.2 Palpitations

R11.10 Vomiting, unspecifiedR09.1

I20.0

Pleurisy

Unstable angina

T67.5XXA Heat Exhaustion, unspecified, initial encounter

T67.0XXA Heatstroke and sunstroke, initial encounter

459.0 Hemorrhage

Uncontrolled or significant signs of shock or other emergency conditions. Severe, active vaginal, rectal bleeding, hematemesis, hemoptysis, epistaxis, active post‐ surgical bleeding. Hemorrhage, Unspecified R58 Hemorrhage, Not Elsewhere Classified (NEC)

987.9 Hazmat

Toxic fume or liquid exposure via inhalation, absorption, oral, radiation, smoke inhalation.

Toxic effect of unspecified gas, fume, or vapor

T59.94XA Toxic effect of unspecified gases, fumes and vapors, undetermined, initial encounter

536.2 Cardiac symptoms

Persistent nausea and vomiting, weakness, hiccups, pleuritic pain, feeling of impending doom, and other emergency conditions. Persistent vomiting

992.5

Heat exposure ‐ potentially life threatening

Hot and dry skin, Temp>105, neurologic distress, signs of heat stroke or heat exhaustion, orthostatic vitals, other emergency conditions. Heat Exhaustion, unspecified

437.9Non‐traumatic headache

With neurologic distress conditions or sudden severe onset

Unspecified cerebrovascular disease




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996.00 Medical device failure

Life or limb threatening malfunction, failure, or complication.

Malfunction of ventilator, internal pacemaker, internal defibrillator, implanted drug delivery service.

Mechanical complication of cardiac device, implant, graft; unspecified

T82.599A Other mechanical complication of unspecified cardiac and vascular devices and implants, initial encounter

I67.89 Other cerebrovascular disease

I69.920

R40.2241

Aphasia following unspecified cerebrovascular disease

Coma scale, best verbal response, confused conversation in the field [EMT or ambulance]

[PWW NOTE: See additional codes related to specific GCS elements under R40]

R52 Pain, unspecified

G89.11 Acute pain due to traumaGeneralized pain780.96Pain, severe, not otherwise specified

Acute onset, unable to ambulate or sit due to intensity of pain.

Pain is the reason for the transport. Use severity scale (7‐10 for severe pain) or patient receiving pharmalogic intervention.

Acute but ill‐defined cerebrovascular disease436 Neurological distress

Facial drooping; loss of vision; aphasia; difficulty swallowing; numbness; tingling extremity; stupor, delirium, confusion, hallucinations; paralysis, paresis (focal weakness); abnormal movements; vertigo; unsteady gait/balance; slurred speech, uanble to speak.




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724.5Back pain, non‐traumatic

Suspect cardiac or vascular etiology

Other emergency conditions, absence of or decreased leg pulses, pulsatile abdominal mass, severe tearing abdominal pain. Backache, unspecified

M54.9

M54.89

Dorsalgia, unspecified

Other dorsalgia

724.9Back pain, non‐traumatic

Sudden onset of new neurologic symptoms.

Neurologic distress list.Other unspecified back disorders M54.9 Dorsalgia, unspecified

977.9

Poisons ingested, injected, inhaled, absorbed

Adverse drug reaction, poison exposure by inhalation, injection, or absorption.

Arthus' phenomenon from administration of incorrect substance

T50.904A

T65.94XA

Poisoning by unspecified drugs, medicaments and biological substances, undetermined, initial encounter

Toxic effect of unspecified substance, undetermined, initial encounter

977.3Severe alcohol intoxication

Airway may or may not be at risk. Pharmacological intervention or cardiac monitoring may be needed. Decreased level of consciousness resulting or potentially resulting in airway compromise.

Poisoning by alcohol deterrents F10.929 Alcohol use, unspecified with intoxication, unspecified

O80 Encounter for full‐term uncomplicated delivery

O26.90Pregnancy related conditions, unspecified, unspecified trimester650

Pregnancy complication / childbirth / labor Normal delivery




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292.9 Psychiatric

Abnormal mental status; drug withdrawal.

Disoriented, DTs, withdrawal symptoms

Unspecified drug‐induced mental disorder

F19.99 Other psychoactive substance use, unspecified with unspecified psychoactive substance‐induced disorder

R11.2 Nausea with vomiting, unspecified

E86.0 Dehydration

R40.4 Transient alteration of awareness

R55 Syncope and collapse780.02

Unconscious, fainting, syncope, near sycnope weakness, dizziness

Transient unconscious episode or found unconscious. Acute episode or exacerbation.

Transient alteration of awareness

787.01 Severe dehydration

Nausea and vomiting, diarrhea, severe and incapacitating resulting in severe side effects of dehydration. Nausea with vomiting




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959.8 Major trauma

As defined by ACS Field Triage Decision Scheme. Trauma with one of the following: Glascow <14; systolic BP<90; RR<10 or >29; all penetrating injuries to head, neck, torso, extremities proximal to elbow or knee; flail chest; combination of trauma and burns; pelvic fracture; 2 or more long bone fractures; open or depressed skull fracture; paralysis; severe mechanism of injury including: ejection, death of another passenger in same patient compartment, falls >20’’, 20’’ deformity in vehicle or 12’’ deformity of patient compartment, auto pedestrian/bike, pedestrian thrown/run over, motorcycle accident at speeds >20 mph and rider separated from vehicle.

Traumatic injury, other and unspecified; including multiple sites T07 Unspecified multiple injuries

J96.00 Acute respiratory failure, unspecified whether with hypoxia or hypercapnia

S09.90XA Unspecified injury of head, initial encounter518.51 Other trauma

Need to monitor or maintain airway

Decreased LOC, bleeding into airway, trauma to head, face or neck.

Acute respiratory failure, following trauma and surgery

Emergency Condition Codes ‐ ALS (Trauma)




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958.2Other trauma ‐ bleeding

Major bleeding

Uncontrolled or significant bleeding.

Secondary and recurrent hemorrhage

T79.2XXA Traumatic secondary and recurrent hemorrhage and seroma, initial encounter

887.4Other trauma ‐ amputation Amputation – arm or Hand

Traumatic amputation of arm and hand

S48.919A

S58.919A

S68.419A

Complete traumatic amputation of unspecified shoulder and upper arm, level unspecified, initial encounter

Complete traumatic amputation of unspecified forearm, level unspecified, initial encounter

Complete traumatic amputation of unspecified hand at wrist level, initial encounter

897.4Other trauma ‐ amputation Amputation – leg or foot

Unilateral traumatic amputation of leg

S78.919A

S88.919A

S98.019A

Complete traumatic amputation of unspecified hip and thigh, level unspecified, initial encounter

Complete traumatic amputation of unspecified lower leg, level unspecified, initial encounter

Complete traumatic amputation of unspecified foot at ankle level, initial encounter




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869.0 Other trauma ‐ closed

Suspected internal, head, chest, or abdominal injuries.

Signs of closed head injury, open head injury, pneumothorax, hemothorax, abdominal bruising, positive abdominal signs on exam, internal bleeding criteria, evisceration Internal organ injuries

S02.91XA

S27.9XXA

S36.90XA

S37.90XA

Unspecified fracture of skull, initial encounter for closed fracture

Injury of unspecified intrathoracic organ, initial encounter

Unspecified injury of unspecified intra‐abdominal organ, initial encounter

Unspecified injury of unspecified urinary and pelvic organ, initial encounter

869.1 Other trauma ‐ open

Suspected internal, head, chest, or abdominal injuries.

Signs of closed head injury, open head injury, pneumothorax, hemothorax, abdominal bruising, positive abdominal signs on exam, internal bleeding criteria, evisceration

Internal organ injuries with open wound into cavity

S01.90XA

S21.90XA

S31.609A

S31.001A

Unspecified open wound of unspecified part of head, initial encounter

Unspecified open wound of unspecified part of thorax, initial encounter

Unspecified open wound of abdominal wall, unspecified quadrant with penetration into peritoneal cavity, initial encounter

Unspecified open wound of lower back and pelvis with penetration into retroperitoneum, initial encounter




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949.3 Burns ‐ major

Major – per American Burn Association (ABA)

Partial thickness burns > 10% total body surface area (TBSA); involvement of face, hands, feet, genitalia, perineum, or major joints; third degree burns; electrical; chemical; inhalation; burns with preexisting medical disorders; burns and trauma

Full‐thickness, skin loss (third degree nos)

T31.10 Burns involving 10‐19% of body surface with 0% to 9% third degree burns

[PWW NOTE: See additional body surface ranges under T31]

989.5 Animal bites, stings

Potentially life or limb‐threatening.

Symptoms of specific envenomation, significant face, neck, trunk, and extremity involvement; other emergency conditions. Toxic effect of venom

T63.94XA

T63.484A

Toxic effect of contact with unspecified venomous animal

Toxic effect of venom of other arthropod, undetermined, initial encounter

994.0 Lightning Effects of lightning

T75.00XA

T75.01XA

Unspecified effects of lightning, initial encounter

Shock due to being struck by lightning, initial encounter

994.8 Electrocution Electrocution and nonfatal effects of electric current T75.4XXA Electrocution, initial encounter

994.1 Near drowning Airway compromised during near drowning event

Drowning and nonfatal submersion

T75.1XXA Unspecified effects of drowning and nonfatal submersion, initial encounter

T76.21XA Adult sexual abuse, suspected, initial encounter

T76.22XA Child sexual abuse, suspected, initial encounterSexual assault With major injuries Adult sexual abuse995.83




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789.00 Abdominal pain Without other signs or symptomsAbdominal pain, unspecified site R10.84 Generalized abdominal pain

692.9Allergies reaction ‐ non life threatening

Hives, itching, rash, slow onset, local swelling, redness, erythema. Dermatitis, unspecified T78.49XA Other allergy, initial encounter

991.9 Cold exposure

With symptoms

Shivering, superficial frost bite, and other emergency conditions

Unspecified effect of reduced temperature

T69.9XXA Effect of reduced temperature, unspecified, initial encounter

379.90 Eye symptoms Acute vision loss and/or severe pain Disorder of eye, unspecified H57.9 Unspecified disorder of eye and adnexa

992.2 Heat exposure

With symptoms

Muscle cramps, profuse sweating, fatigue. Heat cramps T67.2XXA Heat cramp, initial encounter

A41.9 Sepsis, unspecified organism

B99.9 Unspecified infectious disease

996.30 Medical device failure

Health maintenance device failures that cannot be resolved on location.

Oxygen system supply malfunction, orthopedic device failure.

Mechanical complication of genitourinary device, implant, and graft; unspecified

Y82.8 Unspecified medical devices associated with adverse incidents

305.00 Alcohol intoxication

Unable to care for self and unable to ambulate. No airway compromise. Alcohol abuse, unspecified F10.10 Alcohol abuse, uncomplicated

Unspecified septicemia

Emergency Condition Codes ‐ BLS (Non‐traumatic)

038.9

Infectious disease requiring isolation procedures




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998.9

Post‐operative procedure complications

Major wound dehiscence, evisceration, or requires special handling for transport

Non‐life threateningUnspecified complication of procedure NEC

T81.9XXA Unspecified complication of procedure, initial encounter

F29 Unspecified psychosis not due to a substance or known physiological condition

F68.8 Other specified disorders of adult personality and behavior

A39.9 Meningococcal infection, unspecified

R50.9 Fever, unspecified

829.0Other trauma ‐ suspected fracture

Suspected fracture/dislocation requiring splinting/immobilization for transport.

Spinal, long bones, and joints including shoulder elbow, wrist, hip, knee and ankle, deformity of bone or joint.

Fracture of unspecified bone, closed T14.8 Other injury of unspecified body region

880.00Other trauma ‐ penetrating

Penetrating extremity injuries

Isolated with bleeding stopped and good CSM.

Open wound of shoulder region

S41.009A Unspecified open wound of unspecified shoulder, initial encounter

298.9 Psychiatric/behavioral

Threat to self or others, acute episode or exacerbation of paranoia, or disruptive behavior.

Suicidal, homicidal, or violent. Psychosis, unspecified

036.9 Sick person ‐ fever

Fever with associated symptoms (headache, stiff neck, etc.). Neurological changes.

Suspected spinal meningitis.Meningococcal infection, unspecified

Emergency Condition Codes ‐ BLS (Trauma)




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886.0Other trauma ‐ amputation Amputation – digits ‐ fingers

Traumatic amputation of other finger(s)

S68.519A

S68.619A

Complete traumatic transphalangeal amputation of unspecified thumb, initial encounter

Complete traumatic transphalangeal amputation of unspecified finger, initial encounter

895.0Other trauma ‐ amputation Amputation – digits ‐ toes

Traumatic amputation of toe(s)

S98.119A

S98.139A

S98.219A

Complete traumatic amputation of unspecified great toe, initial encounter

Complete traumatic amputation of one unspecified lesser toe, initial encounter

Complete traumatic amputation of two or more unspecified lesser toes, initial encounter

949.2 Burns ‐ minor

Minor – per ABA

Other burns than listed above.Second degree burn, unspecified T30.0 Burn of unspecified body region, unspecified degree

879.8 Animal bites/stings

Local pain and swelling or special handling considerations (not related to obesity) and patient monitoring required. Multiple open wounds

S81.859A

S51.859A

W57.XXXA

Open bite, unspecified lower leg, initial encounter

Open bite of unspecified forearm, initial encounter

Bitten or stung by nonvenomous insect and other nonvenomous arthropods, initial encounter

921.9 Eye injuries

Acute vision loss or blurring, severe pain or chemical exposure, penetrating, severe lid lacerations.

Contusion of eye and adnexa; unspecified

S05.90XA Unspecified injury of unspecified eye and orbit, initial encounter




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T76.91XA Unspecified adult maltreatment, suspected, initial encounter

T76.92XA Unspecified child maltreatment, suspected, initial encounter

Y71.0Diagnostic and monitoring cardiovascular devices associated with adverse incidents

I49.8 Other specified cardiac arrhythmiasJ96.90 Respiratory failure, unspecified, unspecified whether

with hypoxia or hypercapnia

Z99.11 Dependence on respirator/ventilator status

F05 Delirium due to known physiological condition

F91.9 Conduct disorder, unspecified

J44.9 Chronic obstructive pulmonary disease, unspecified

Z99.89 Dependence on other enabling machines and devices

786.09 Airway control Dyspnea and respiratory abnormalities, other R06.89 Other abnormalities of breathing

J43.9 Emphysema, unspecified

Z99.81 Dependence on supplemental oxygen

995.80 Sexual assault With minor or no injuries Adult abuse, unspecified

428.9 Cardiac monitoring Expectation monitoring is needed before and after transport. Heart failure, unspecified

492.8

Third party assistance/attendant required to apply, administer, or regulate or adjust oxygen en route.

Does not apply to patient capable of self‐administration of portable or home O2. Patient must require oxygen therapy and be so frail as to require assistance.

Non‐emergency Condition Codes ‐ ALS

Non‐emergency Condition Codes ‐ BLS

Airway management

Ventilator dependent, apnea monitor, possible intubation needed, deep suctioning. Acute respiratory failure518.81

293.0 Chemical restraint Delirium due to conditions classified elsewhere

Other emphysema

496

Suctioning required en route, need for O2 therapy

Chronic airway obstruction NEC




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F29 Unspecified psychosis not due to a substance or known physiological condition

Z78.1 Physical restraint status

F05 Delirium due to known physiological conditionF91.8

Z74.3

Other conduct disorders

Need for continuous supervision

F23 Brief psychotic disorder

F69 Unspecified disorder of adult personality and behaviorR27.9

R27.0

R27.8

Unspecified lack of coordination

Ataxia, unspecified

Other lack of coordinationZ91.81

Z74.01

Z74.09

History of falls

Bed confinement status

Other reduced mobility781.3

Patient safety: Risk of falling off wheelchair or stretcher while in motion (not related to obesity). Lack of coordination

293.1

Patient safety: Danger to self or others – monitoring.

Behavioral or cognitive risk such that patient requires monitoring for safety. Subacute delirium

298.8

Patient safety: Danger to self or others – seclusion (flight risk).

Behavioral or cognitive risk such that patient requires attendant to assure patient does not try to exit the ambulance prematurely. Refer to 42 CFR Section 482.13(f) for definition. Other reactive psychosis

298.9

Patient safety: Danger to self or others – in restraints. Psychosis, unspecified




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B96.89 Other specified bacterial agents as the cause of diseases classified elsewhere

B99.9

Z51.89

Unspecified infectious disease

Encounter for other specified aftercareS14.109S

S24.109S

S34.109S

S34.139S

Unspecified injury at unspecified level of cervical spinal cord, sequela

Unspecified injury at unspecified level of thoracic spinal cord, sequela

Unspecified injury to unspecified level of lumbar spinal cord, sequela

Unspecified injury to sacral spinal cord, sequelaT84.84XA Pain due to internal orthopedic prosthetic devices,

implants and grafts, initial encounter907.2

Special handling en route to reduce pain – orthopedic device.

Special handling en route to reduce pain – orthopedic device.

Backboard, halotraction, use of pins and traction etc. Pain may be present.

Late effect of spinal cord injury

041.9Special handling en route – isolation.

Includes patients w/communicable diseases or hazardous material exposure who must be isolated from public or whose medical condition must be protected from public exposure; surgical drainage complications.

Unspecified bacterial infection in condition classified elsewhere




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M25.559 Pain in unspecified hip

M24.50

L89.119

L89.209

L89.309

L89.90

Contracture, unspecified joint

Pressure ulcer of unspecified part of back, unspecified stage

Pressure ulcer of unspecified hip, unspecified stage

Pressure ulcer of unspecified buttock, unspecified stage

Pressure ulcer of unspecified site, unspecified stage

NEW Bed Confined

Patient is: (1) unable to get up from bed without assistance, (2)

unable to ambulate, and (3) unable to sit in a chair or wheelchair. All

three must be true for this condition to apply NEW Z74.01 Bed confinement status

719.45

Special handling en route – positioning requires specialized handling.

Requires special handling to avoid further injury (such as with > grade 2 decubiti on buttocks). Generally does not apply to shorter transfers of < 1 hour. Positioning in wheelchair or standard car seat inappropriate due to contractures or recent extremity fractures – post‐op hip as an example.

Joint pain, pelvic region and thigh



YES NO

Billing Narrative (Summary of documented medical necessity and reasonableness for ambulance transport):

Complete Call Intake/Dispatch Information Received?

©Copyright 2015, Page, Wolfberg & Wirth, LLC. This Form Does Not Constitute Legal Advice.

Sample ICD‐10 Readiness Billing and Coding Worksheet

User Bears All Responsibility for Proper Documentation and Billing and Releases PWW From Any and All Liability for Use.

Documentation Requirements Satisfied for Proper Coding and Billing

Call/Run #: Patient Name: Call Date:

Was the dispatch a result of a 911 call or the equivilent?

Base Rate indicated based on dispatch information:

Additional Forms/Information Received For Non‐Emergency Transports?

ABN properly completed if required? (Check box if N/A)

Patient AOB signature requirements met?

Does the PCR paint a clear picture of the patient's condition and services provided?Are all interventions and services provided clearly documented?

Was the patient's reported condition at the time of dispatch clearly documented?

Was a full and complete assessment documented, pertinent to the chief complaint?

Are any of the documented interventions "ALS interventions"?Does the PCR adequately document the medical necessity for all services/interventions?

Patient Care Report (PCR) documentation requirements met?

PCS signed and dated by authorized PCS signer, and "in hand" at the time required?PCS documents that ambulance transport was medically necessary?

Appropriate ICD‐9 Code(s) for this transport?Appropriate ICD‐10 Code(s) for this transport?

Appropriate Base Rate, based on both dispatch and PCR information:

What are the appropriate Origin and Destination Modifiers?Are there any applicable "Second Modifiers"? Yes No (If "Yes" what are they?)

Summary of pertinent facts for determination of appropriate ICD‐9/ICD‐10 code(s):

Was loaded fractional mileage documented? If "Yes", Qty:

Does the PCR document the credentials of all crewmembers?

Was an "Immediate Response" medically necessary, based on the dispatch determinant?

Was an "ALS Assessment" required, based on the patient's reported condition?

Coding Determinations Based on Documents Provided and Reviewed

Did all crew members sign the PCR?

Was the patient transported to a covered destination?Is the ZIP Code of the pickup location documented?Was this transport "Reasonable", based on the Pt's documented condition?Was this transport "Medically Necessary", based on the Pt's documented condition?Is the PCR internally consistent (no unresolved inconsistencies in the PCR)?

If "Yes", was an "ALS Assessment" provided and documented?

If "Yes", was an "Immediate Response" provided and documented?

this

CCeerrttiiffiiccaattee ooff CCoommpplleettiioonn is presented as evidence of completion, by the Certified Ambulance Coder®, Certified Ambulance

Compliance Officer™ or Certified Ambulance Privacy Officer™ whose Signature and Certification

Number appear below, of the NAAC® approved Continuing Education course entitled

PWW - 2015 - ICD-10 Part II - Coding

Course ID: 1578 Vendor Code: 6 Topic Code: 2 CEU Units: 1.5

Education Provider: Page, Wolfberg & Wirth Presenter: PWW Staff

Jason J. Leet NAAC

® Program Coordinator

5/13/2015 Date of Training

I hereby certify that I have completed the continuing education training as represented on this certificate.

Signed: ______________________________________________________ NAAC® Certification Number ________________________________

Certificate is invalid without the signature and certification number of the attendee.