What a Pain!

We do pain!

A lot of what we do in EMS involves patients in pain. Pain is a key component of medical emergencies and traumatic injuries of all shapes and sizes.

While it may not be the patient’s chief complaint, there’s no doubt that a majority of the scenarios we respond include a pain response.

Today we take a look at how to support billing claims when pain is involved in the scenario.

Scene to Documentation to Claim

When it comes to EMS billing, the first and most important key to submitting a claim for billing begins with the documentation of the event in the Patient Care Report (PCR).

Documenting pain must be qualitative, quantitative and location oriented when chronicling the scenario in the PCR. There may have been a day long ago that a PCR could contain general statements such as…

“Arrived on scene to find a 39 year old female complaining of abdominal pain, placed patient on stretcher and transported to hospital”

Know this… those days are gone!

Today, given the new claim supporting requirements contained in many Medicare Local Coverage Determinations (LCD’s) or the narrow medical necessity rules of many States’ medical assistance programs and even laser claim review processes of commercial insurance payers such vague, non-specific documentation is just not robust enough to support effective claim submission by your billing office.


Just about every claim processing guidance document we read directly includes or at a minimum implies the requirement of including a rating number in the PCR. You are answering the question; How much pain is your patient experiencing, for the reviewer.

Doing so is quite simple, really, of course assuming our patient is able to communicate with us effectively.

For example, “Patient stated that she has been experiencing increasing amounts of pain in her abdomen over the past two hours and currently indicates her pain level to be an “9” on a 1-10 severity scale.”

It’s hard for any claim reviewer to not understand that this patient is clearly in a considerable amount of distress that definitively requires further examination by qualified medical personnel.

Note also that our documentation example also includes an element of noting the duration in time of the pain complaint.


Another way to effectively support medical necessity when documenting pain is to ask your patient to qualify his/her pain event. What type of pain does your patient have?

“The patient stated that her pain was a sharp, stabbing pain rated as a “9” on a 1-10 scale that has remained constant since the onset some twenty minutes ago.”

Pain invites qualifying, descriptive words such as sharp, dull, stabbing, crushing, aching, moderate, or severe for example. Patients will most likely be eloquent in their descriptions to qualify the event without much coaching, at least we’ve noted that to be our experience.


Another key element to document when recording a pain event in your PCR is to be sure to note the location and be sure not to forget referring pain, as well.

“Patient stated pressure-like abdominal pain of “6” on a 1-10 scale is primarily located in the upper right quadrant of the abdomen, with radiation into her right chest and shoulder area.”

Of course it is also important to document your assessment, especially hands-on palpation of the area with assessment for deformities, masses and other potential abnormalities even with consideration of comparisons for deviation from symmetry when compared to opposite parallel parts of the body.

“EMT Smith palpated the right flank finding notable deformity consistent with a traumatic injury to the rib cage with possible rib fractures. Patient loudly complained of aching pain rated as “7” on a 1-10 scale upon palpation of the affected area.”

Additionally- Primary or Secondary?

In concluding this discussion, have you documented if the patient’s pain is the primary reason why he/she activated the EMS system or is your patient’s pain secondary to a contributing factor?

Note the two approaches for charting our events…

“Patient activated the EMS system when she began experiencing severe, stabbing chest pain noted by the patient to be a “10” on a 1-10 scale at approximately 1100 hours this date.”


“Patient suffered a fall from a ladder prior to activating the EMS system which resulted in a suspected fracture to the distal portion of the left lower extremity resulting in sharp pain rated by the patient as “8” on a 1-10 scale in the area of the left ankle.”

The first example tells of pain that primarily initiated the EMS event. The second example, notes the pain as a secondary factor to the main event which was the traumatic injury.

Effective Charting = Effective Billing

So, there you have it. Basically effective charting of your EMS event will equate to effective billing by collecting adequate reimbursement dollars from the payer source.

We offer continual education to our clients and stresses the importance of using clear, concise and clinical documentation techniques to support the billing of ambulance claims to all payer sources. Not only do we provide continual, ongoing education opportunities such as this blog space, but we also provide in-person or web-based documentation training sessions for the benefit of administrators, call takers and rank-and-file street crew members, as well.

If your crews aren’t continually learning about how to effectively write PCR’s, maybe it’s time to check out what we can offer to your department. Current clients can review archives of this blog space for education possibilities or contact your Client Services representative for more details on what’s available to you and your staff.

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