Ambulance Coding
Many municipalities contract with private ambulance and patient transport services. Due to the specific and complex requirements of ambulance billing, Medicare and the Office of Inspector General (OIG) have increased their oversight efforts in this area. With billions spent annually on emergency medical services by Medicare and Medicaid, ambulance coding remains a consistent focus on the OIG’s annual work plan. As more individuals from the postwar baby boomer generation become eligible for Medicare, scrutiny around ambulance billing is expected to intensify further.
Ambulance & Emergency Medicine Coding
The differences between medical and ambulance coding are significant. Ambulance coding has its own set of codes and documentation requirements, which differ greatly from those used by physician and hospital coders. For instance, EMS personnel are not licensed to diagnose, so condition codes must be used instead of diagnostic codes—only a physician can provide a formal diagnosis. Additionally, the patient's actual condition upon ambulance arrival may differ from the reason for dispatch, and strict rules dictate which condition should be reported on the claim. In some cases, a patient may have even passed away before the ambulance arrived. These and many other unique factors must be carefully considered by ambulance coders to ensure claims are accurate and compliant.
Ambulance coding is important.
Ambulance coding differs significantly from medical specialties that use evaluation and management (E/M) codes to document provider services. Instead, it follows its own set of complex rules and requirements specific to EMS. The Coding Network’s Ambulance Coding Division offers specialized, high-quality coding services for ambulance and EMS providers, utilizing a team of Certified Ambulance Coders® (CAC) who are experts in the field.
Ambulance Coding Background
The Coding Network is led by a nationally recognized ambulance coding expert and backed by decades of experience in remote medical coding. Our strength lies in a dedicated network of certified ambulance coders, each with specialized expertise in EMS billing. This allows us to deliver consistent, accurate, and audit-ready results—no matter the volume or complexity of your claims.
A physician is a medical professional who diagnoses and treats illnesses, provides routine care, and helps patients stay healthy. They are essential to maintaining individual and community health.
Facility coding involves assigning codes for hospital or clinic services like procedures, equipment, and room charges. It ensures accurate billing and reimbursement for the healthcare facility.
Facility coding involves assigning codes for hospital or clinic services like procedures, equipment, and room charges. It ensures accurate billing and reimbursement for the healthcare facility.
An ambulance is a specially equipped vehicle used to transport sick or injured individuals to medical facilities. It provides emergency care on the way, often staffed by paramedics or EMTs.
HCC Risk Adjustment Coding uses diagnosis codes to estimate a patient’s future healthcare costs. It assigns a Risk Adjustment Factor (RAF) score based on medical conditions and demographics, helping ensure accurate reimbursement in value-based care models.
HCC Risk Adjustment Coding uses ICD-10-CM codes to capture a patient’s health conditions and calculate a Risk Adjustment Factor (RAF) score. This score helps determine reimbursement in value-based care by reflecting patient complexity
