Secondary diagnosis is must ambulance service

Effective with services rendered October 1, 2015 and later, ALL ambulance transports require dual diagnoses. Providers should report the primary diagnosis as the most appropriate ICD-10 code that adequately describes the patient’s medical condition at the time of transport. In addition, a secondary diagnosis must be reported which reflects the patient’s need for the ambulance service and ambulance personnel at the time of transport. In order for claims to be processed and paid in a timely manner it is important that claims submitted for ambulance services contain both the primary and secondary diagnosis.

Please refer to the Ambulance Local Coverage Article A54574 for a list of “suggested” ICD-10 codes that may be reported as a primary diagnosis. Please note that the list of diagnosis codes provided in A54574 is not an all-inclusive list. Other valid ICD-10 diagnoses codes that accurately describe the patient’s condition at the time of transport may be reported as a primary diagnosis. Please refer to the Ambulance Local Coverage Determination (LCD) Policy for a list of four covered secondary diagnosis codes (Z codes). The secondary diagnosis code should reflect why the transport is reasonable and necessary. If the transport is not reasonable and necessary the LCD provides a non-covered Z code.

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