# ALS Assessment?



## Jon (Nov 4, 2008)

The billing forms I'm seeing everywhere have an option for "BLS transport, ALS assessment". Medicare will apparently pay ALS1 rate for a BLS transport with an ALS assessment. http://www.cms.hhs.gov/manuals/Downloads/bp102c10.pdf

We were talking the other day... and we couldn't figure out what Medicare defines as an ALS assessment.

Is it the medic LOOKING at the patient?
Is it the medic Looking and Touching the patient?
Is it the medic putting the patient on the ECG monitor?

All 3?

Can anyone cite a reference?

Thanks,

Jon


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## Ridryder911 (Nov 4, 2008)

Usually an ALS assessment is one that is performed by an licensed ALS provider. This is usually accompanied by documentation such as an ECG, FSBS, EtCo2, etc. that data has to be interpreted to aid in making a diagnosis. 

R/r 911


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## 41 Duck (Nov 4, 2008)

*Whee!*

Yep.  Here come the MICUs...

Ugh.


Later!

--Coop


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## Hastings (Nov 4, 2008)

I'll be honest. I try to save my patients as much money as possible, but I can't remember any time when I have NOT checked the ALS assessment box. I'm a Paramedic, and I'm assessing them, so...


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## firecoins (Nov 5, 2008)

You pay for seeing the medic when to medic could be somewhere else.  His time is valuable.


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## marineman (Nov 5, 2008)

Honest question, since our service is all medics does that mean that medicare should pay ALS1 for all calls?


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## Ridryder911 (Nov 5, 2008)

marineman said:


> Honest question, since our service is all medics does that mean that medicare should pay ALS1 for all calls?



No, actually ALS1 calls are responses that medications are administered. Such interventions such as < 3 in a category. More than 3 such as Morphine, Lasix, NTG are an ALS2. The separation is specific such as NTG cannot count as administered 2 times and 1 M.S. would not be an ALS 2 call. 

An ALS provider can provide a BLS call if no ALS intervention such as an ALS assessment, then per Medicare it would be an BLS call. Detailed assessment such as advanced nuero, ECG, etc. would make it an ALS call. 

R/r 911


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## marineman (Nov 5, 2008)

Does starting an IV qualify for an ALS intervention and does a saline lock count as an IV? That's almost universal in our system now, probably 90% of patients even if getting no fluids will get a lock. I worked in billing about 4 years ago but haven't done anything with it since then.


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## medicdan (Nov 5, 2008)

Just to clarify:

BLS assesment, BLS transport -- BLS billing
ALS assesment, BLS transport (on ALS rig)--- ALS1 billing (Rid, you confuse me)
ALS assesment, ALS transport --- ALS1/2 billing (depending on interventions)
ALS assesment on scene, downgrade to BLS transport (BLS rig)-- ?? ALS1. 
What if ALS took an ECG, FSBS or ETCo2, then downgrades, is it then ALS1+ abandonment?

Did this make sense? Medicare has never made sense to me, but this seems to be warped.


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## Ridryder911 (Nov 5, 2008)

Medicare pays for emergency calls based upon how they were received i.e. emergency or non-emergency, not how they were transported. As well, one has to be able to clarify if an advanced assessment was performed such as the use of an ECG to rule out or FSBS, again documentation of an advanced assessment or monitoring that requires an advanced level.

The ALS1 and ALS2 is in regard to the number of medications and treatment administered. ALS1 should not be billed if it is a simple basic call, where a there is no advanced intervention as an assessment or therapy. 

IV saline lock is considered the same as IV therapy.  

R/r 911


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## MJordan2121 (Nov 5, 2008)

On our truck, we have a basic and a paramedic on board. There are times when we have multiple patients and I (the basic) perform an assessment and the medic may not even see that particular patient, unless there lies that suspicion that something is going on that I may not be able to particularly handle. However, we still charge for an ALS rate regardless. It is part of our contract with the counties we work in.


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## Jon (Nov 14, 2008)

I hate to bring this up again... does anyone have an official interpretation from Mediscare of where an ALS assessment begins?


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