# Reasons forBLS transport



## Draconicwraith (Mar 22, 2013)

I am currently having an argument with management about reasons for BLS transport over wheelchair van.  They are currently under the impression that isolations (VRE, MRSA, AIDS, HEP-C, ect...) are able to be transported via wheelchair van, and are not reasons for BLS transport.  I am trying to find any proof one way or the other on paper,and can't find anything.  Any help would be appreciated!


----------



## adamjh3 (Mar 22, 2013)

I can't answer your question because I don't know, but BillingSpecialist from  this thread might be able to help if the question hasn't been answered there already.


----------



## Aidey (Mar 22, 2013)

It's going to depends on the patient. Considering millions of people walk about with the various types of Hepatitis and HIV/AIDS and aren't under isolation precautions you're going to have a hard time making your case.


----------



## Draconicwraith (Mar 22, 2013)

Aidey said:


> It's going to depends on the patient. Considering millions of people walk about with the various types of Hepatitis and HIV/AIDS and aren't under isolation precautions you're going to have a hard time making your case.



Medical necessity states they need BLS transport for isolations of MRSA, for example.  Management is telling me it's not a valid reason for BLS transport.


----------



## Aprz (Mar 22, 2013)

There is a post on medical billing here.

The 10 presumptive medicare criteria are:
1. Unconscious or shock
2. Emergency (eg car accident)
3. Restraints
4. Immobilization or c-spine
5. Hemorrhage
6. Bed confined*
7. Requires oxygen
8. Stroke
9. Can only be moved by stretcher
10. Respiratory or cardiovascular emergency

* Not a good enough reason by itself.

As you can see, isolation precautions is not a criterion that an ambulance company can bill for reason the patient required an ambulance.


----------



## Veneficus (Mar 22, 2013)

It is estimated the 20% (1/5) people are MRSA carriers. We would have to isolate an aweful lot of people around the world.


----------



## FLdoc2011 (Mar 22, 2013)

Yea, I don't see MRSA colonization itself justifying or necessitating BLS transport.


----------



## Draconicwraith (Mar 22, 2013)

Yet if that is the case, why are isolations the 2nd item on t he medical necessity forms, under bed confined?  Also, look ukulele g at the medicare and medicaid documentation for at least 6 states so far, it clearlybstates that isolations cannot be transported via wheelchair van.


----------



## Draconicwraith (Mar 22, 2013)

What wheelchair van driver who is not an emt will know how to handle an isolation patient?


----------



## Veneficus (Mar 22, 2013)

Draconicwraith said:


> What wheelchair van driver who is not an emt will know how to handle an isolation patient?



All he has to do is wash his hands...


----------



## Draconicwraith (Mar 22, 2013)

Veneficus said:


> All he has to do is wash his hands...


  And decon the van.  Again,  most drivers are not trained to do this.


----------



## Veneficus (Mar 22, 2013)

Draconicwraith said:


> And decon the van.  Again,  most drivers are not trained to do this.



That is a fancy way to say "keep the thing clean."

I think you are putting more thought into this than it requires. 

In your original post you mentioned HIV and Hep C patients. There are people walking around in the general populous all the time. They don't need isolation or an ambulance.

If they have active TB or some other condition requiring droplet precautions, they should be in a mask. What stops them from taking a taxi instead of an ambulance?

If you are looking for a sterile environment, most people have more than 86 different organisms as normal body flora. We do not live in a sterile environment and in fact you wouldn't be able to survive if you did. 

If you do a little bit of self research you will find that "reasonable" precautions do not mean total isolation in all but the most serious of diseases. 

Yea, if the guy had ebola, maybe ambulance transport would be indicated.

Also consider your company may be erring on the side of caution. It is a criminal offense to bill medicare/medicade for BLS transport fo those who  not needing it. Considering the difference in revenue, I would bet your company looked into this.


----------



## Aidey (Mar 22, 2013)

Draconicwraith said:


> Medical necessity states they need BLS transport for isolations of MRSA, for example.  Management is telling me it's not a valid reason for BLS transport.



I think you are looking at this backwards. Just because someone meets one of the criteria on the PCS form doesn't mean they also meet medical necessity. Oxygen is listed on those forms, but again, millions of people are on home O2 and they don't travel everywhere by ambulance. 

For isolation precautions to meet medical necessity the person needs to either be protected from other people, or people need to be protected from the patient. This means something like an active MRSA infection in a open skin wound, or a cancer patient with no immune system.


----------



## Handsome Robb (Mar 23, 2013)

We have a massive list of reasons the patient needs ambulance transport that we go through and check all that apply on IFT charts.

Iso precautions is one of them but I don't see it myself being a good enough reason by itself to bump from wheel chair van to ambulance. I'm not in billing, that's just my opinion. Using "they don't know how to clean up" as your reason as to why it should be a BLS call isn't going to cut it. In all reality how much does your run-of-the-mill EMT know about different infectious diseases like VRE or MRSA? They don't teach that in class. With that said what's a fun fact about c-diff that lots of people ignore when it comes to cleanliness? I'll give you a clue, hand sanitizer doesn't cut it, now you tell me why.

My ex was a wheelchair can girl. She transported patients with all the conditions you noted above and patients on oxygen pretty regularly to their scheduled doctors appointments.

Transporting a patient on contact iso precautions doesn't mean you have to decon the entire van, just what came into contact with the patient. It takes very little time to tea h someone to wipe surfaces down, wear gloves and To pay attention to what they touch with said gloves after they've touched the patient.


----------

