Anthem Central Region Clinical Claims Edit
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- Leonard Randall
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1 Please compare the claim's date of adjudication to the range of the edit in question. Prior versions, if any, can be found below. Subject: Electrocardiogram (ECGs) with Ambulance AL & BLS Services Edit #: 466 Effective Date: 10/22/ /31/2099 Status: Current Last Review Date: 12/10/2004 Edit (Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report) and (Rhythm ECG, one to three leads; tracing only without interpretation and report) bundles with (Ambulance service, advanced life support, non-emergency transport, level I {ALS}), (Ambulance service, advanced life support, emergency transport, level I {ALS I-emergency}), (Ambulance service, basic life support, non-emergency transport {BLS}), (Ambulance service, basic life support, emergency transport {BLS-emergency}), (Ambulance service, conventional air services, transport, one way {fixed wing}), (Ambulance service, conventional air services, transport, one way {rotary wing}), (Paramedic intercept {PI}, rural area, transport furnished by a volunteer ambulance company which is prohibited by state law from billing third party payers), (Advanced life support, level 2 {ALS 2}), (Specialty care transport {SCT}), (Ambulance transport provided between the hours of 7 p.m. and 7 a.m.), and (Unlisted ambulance service) (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report), (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only), (Rhythm ECG, one to three leads; with interpretation and report) and (Rhythm ECG, one to three leads; interpretation and report only) bundles with (Ambulance service, advanced life support, nonemergency transport, level I {ALS}), (Ambulance service, advanced life support, emergency transport, level I {ALS I-emergency}), (Ambulance service, basic life support, non-emergency transport {BLS}), (Ambulance service, basic life support, emergency transport {BLSemergency}), (Ambulance service, conventional air services, transport, one way {fixed wing}), (Ambulance service, conventional air services, transport, one way {rotary wing}), (Paramedic intercept {PI}, rural area, transport furnished by a volunteer ambulance company which is prohibited by state law from billing third party payers), (Advanced life support, level 2 {ALS 2}), (Specialty care transport {SCT}), (Ambulance transport provided between the hours of 7 p.m. and 7 a.m.), and (Unlisted ambulance service). Page 1 of 5
2 CODE RULE CODE Rationale for Edit: Anthem Central Region bundles or as incidental with,,,,,,,,, and. Based on Medicare s Ambulance Service, Fee Schedule Final Rule, -February 27, 2003, states: We determine that the billing codes that represent items and services included under the ambulance fee schedule are all billing codes submitted by ambulance supplies in the range of Health Care Common Procedure Coding System 9HCPCS) A0030 through (excluding HCPCS code A0888, which is not covered by Medicare) and Common Procedural Terminology- Fourth Edition (CPT-4) codes and HCPCS billing codes A0030 though represent ambulance services, supplies and equipment that are covered by ambulance fee schedule, and CPT codes and represent electrocardiogram (EKG) services that may be billed by ambulance supplier. Page 2 of 5
3 Anthem follows Medicare guidelines as listed above and does not reimburse for electrocardiogram tracing with ALS or BLS ambulance services. Therefore, if or is submitted with ambulance services,,,,,,,,, and )-- only the ambulance service reimburses. Anthem Central Region bundles 93000, 93010, and as incidental with,,,,,,,,, and. Anthem does not reimburse for other EKG/ECG services (global service {93000 or 93040} or for the interpretation and report services {93010 or 93042}) along with ALS or BLS ambulance services. Therefore, if or is submitted with -, or only -, or reimburses. Reference Information: 1. Centers for Medicare and Medicaid (February 27, 2002) Ambulance Fee Schedule Final Review. Retrieved November 22, 2004 from the World Wide Web: Prior Version(s), if any, of this edit can be found below {Times New Roman 14} Please compare the claim's date of adjudication to the range of the edit in question. Prior versions, if any, can be found below. Subject: Electrocardiogram (ECGs) with Ambulance AL & BLS Services Edit #: 466 Effective Date: 7/15/ /21/2005 Status: Prior Last Review Date: 11/19/2004 Edit Page 3 of 5
4 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report), (Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report) and (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) does not bundle with (Ambulance service, advanced life support, non-emergency transport, level I {ALS}), (Ambulance service, advanced life support, emergency transport, level I {ALS I- emergency}), (Ambulance service, basic life support, non-emergency transport {BLS}), (Ambulance service, basic life support, emergency transport {BLS-emergency}), (Ambulance service, conventional air services, transport, one way {fixed wing}), (Ambulance service, conventional air services, transport, one way {rotary wing}), (Paramedic intercept {PI}, rural area, transport furnished by a volunteer ambulance company which is prohibited by state law from billing third party payers), (Advanced life support, level 2 {ALS 2}), (Specialty care transport {SCT}), (Ambulance transport provided between the hours of 7 p.m. and 7 a.m.), and (Unlisted ambulance service) (Rhythm ECG, one to three leads; with interpretation and report), (Rhythm ECG, one to three leads; tracing only without interpretation and report) and (Rhythm ECG, one to three leads; interpretation and report only) bundles with (Ambulance service, advanced life support, nonemergency transport, level I {ALS}), (Ambulance service, advanced life support, emergency transport, level I {ALS I-emergency}), (Ambulance service, basic life support, non-emergency transport {BLS}), (Ambulance service, basic life support, emergency transport {BLSemergency}), (Ambulance service, conventional air services, transport, one way {fixed wing}), (Ambulance service, conventional air services, transport, one way {rotary wing}), (Paramedic intercept {PI}, rural area, transport furnished by a volunteer ambulance company which is prohibited by state law from billing third party payers), (Advanced life support, level 2 {ALS 2}), (Specialty care transport {SCT}), (Ambulance transport provided between the hours of 7 p.m. and 7 a.m.), and (Unlisted ambulance service). CODE RULE CODE Separate Reimbursement Page 4 of 5
5 Rationale for Edit: Anthem Central Region does not bundle (12 lead ECGs) with ambulance services -, or but bundles (3 lead ECGs) with ambulance services -, or. Anthem does not reimburse separately for 3 lead ECGs since they are part of the normal service that is performed by either BLS or ALS ambulance services, but reimburses for 12 lead ECGs services since they not are the normal routine ECG services that is normally performed for ALS or BLS emergency transportation. Therefore, if is submitted with -, or both the ambulance service and the ECG reimburses separately; but if is submitted with -, or only the ambulance service reimburses. Page 5 of 5
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