American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

2019 Intensive Trauma and Critical Care Coding

Who Should Attend This Course

General Surgeons

Getting paid is a team effort—and surgeons lead the team. If the doctors don't understand what's needed in an operative report from a coding and reimbursement point of view (something they don't teach in residency) they are shortchanging themselves.

Practice Administrators and Managers

You are the chief compliance officer in most private practices. In order to supervise the economic engine of the practice, you must understand the business office operations.

Coders and Billers

If you're responsible for entering data, working denials, applying modifiers, posting payments, and filing appeals, your expertise in surgical and office coding must be exacting in its execution!

Hospital or MSO Executives Running General Surgery Practices

Maximize your profits! Understand what is special and unique about billing for the general surgery service line, and keep your surgeons happy and bonus-able. (Not to mention reduce compliance headaches.) Learn the rules and avoid using incorrect and expensive assumptions that result in fiscal disaster.

Register now!

Learning Objectives

As a result of this course participants will be able to:

  • Discuss how the pre, intra and post-operative component of trauma procedures are valued.
  • Describe how surgical modifiers are used in trauma and how they impact payment.
  • Describe accurate coding of common surgical trauma scenarios.
  • Apply coding concepts to complex trauma surgeries, including multiple injuries and damage control surgery.
  • Identify scenarios when critical care coding is appropriate and when it is not.

What's On the Agenda

The Global Surgical Package

  • Deconstructing your payment. How do payors value physician services?
  • Understanding relative value units, surgical splits and time based valuation
  • What's included in a 90-day global package and what's separately reported?

Surgeon Role Modifiers

  • Co-surgeon vs. Assistant: Are you reporting these correctly?
  • Payor expectations for co-surgeon and assistant surgeon documentation
  • Reimbursement: Difference between co- or assistant surgeon

Same-Day Surgical Procedure Modifiers

  • Modifier 22: When is it appropriate to use a 22 and will it get paid?
  • Modifier 50: Which procedures accept a bilateral modifier?
  • Modifiers 52 vs. 53: What's the difference? How is each used in trauma and general surgery
  • Modifier 51 vs. 59: How do you know which one to use? How does reimbursement differ for each?

Surgical Services Performed During the Global Surgical Period

  • Modifier 58: Documenting staged procedures. Do they always need to be pre-planned?
  • Modifier 79: What defines an unrelated procedure? Is a different diagnosis essential?
  • Modifier 78: Does this apply to in-office procedures?
  • How does each modifier impact reimbursement?

Highlights of Trauma Diagnosis Coding

  • Co-morbidities and other injuries: to code or not to code
  • Diagnosis codes that support critical care
  • Solving the mystery of choosing the seventh character

Trauma Procedure Coding

  • Central Venous Catheter Coding
  • Emergent procedures: Chest tube, Intubation, tracheostomy, Pericardial window, tPA in chest tubes, Wound exploration, Thoracotomy, Resuscitation, Hemorrhage management
  • Imaging and the trauma surgeon: FAST exams, Other imaging
  • Trauma surgery coding: Liver, spleen, intestine resection/repair and more; Fasciotomies; Damage control surgery; Wound vac coding; Reporting multiple trauma, what's separately reportable
  • Vessel repair and vessel ligation: Is it separately reported?
  • Case scenarios

Wound Repair Coding: Dos and Don'ts

  • Simple, intermediate, complex repairs: When are they reported with trauma care?
  • Debridement/wound care therapy: Wound vac use and reimbursement

E/M and Critical Care Coding: Introduction

  • Critical care is an audit target! Minimizing your risk by accurate documentation
  • Critical care coding and the trauma surgeon

Defining Critical Care

  • Medicare vs CPT

Critical Care and Place of Service: Where Can Critical Care Be Reported

  • ED, inpatient, ICU. Is there a difference?

Calculating Time in Critical Care

  • Services That Can Be Included in the Calculation of Critical Care Time
  • Services That May Not Be Included in Critical Care Time
  • Applying the primary and add-on critical care codes with different providers
  • Documenting time

Concurrent Critical Care Coding

  • Partners of the same specialty
  • Physicians of different specialties
  • Trauma surgeon and intensivists. Who bills?
  • The trauma surgeon as an intensivist. How does billing change?

Critical Care Services and Other E/M Services Provided on Same Day

  • Can both be billed? Does sequence matter?
  • Medicare
  • CPT

Coding Critical Care Services During Preoperative and Postoperative Portion of Global Period of Procedure with 90-Day Global Period

  • In Trauma Cases
  • In other scenarios
  • Applying E/M modifiers

Teaching Physicians and Critical Care: Billing Imperatives

Billing Critical Care for Nurse Practitioners and Physician Assistants

Documenting Critical Care

  • Supporting documentation: What justifies medical necessity and what does not.
  • Examples of acceptable and unacceptable critical care documentation
  • Critical care scenarios