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

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:

  • Describe the surgical global package and what is separately reported for trauma and critical care services
  • Distinguish documentation for co-surgeon versus and assistant surgeon services for multiple trauma cases
  • Correctly apply surgical and E/M modifiers for trauma and critical care
  • Recognize correct trauma diagnosis coding
  • Correctly code a variety of trauma procedures and services, including imaging, thoracotomy, damage control surgery, liver, colon and other injuries, vessel repair and sacrifice and new vessel exploration codes
  • Differentiate between critical care and non-critical care E/M services
  • Demonstrate how to report and document critical care time
  • Recognize correct reporting of critical care services within a surgical global period
  • Recognize how to report critical care as a teaching physician  

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?

Documenting and Reporting Co-Surgeon and Assistant Surgeon

  • Co-surgeon vs. Assistant: Are you reporting these correctly?
    • Multiple trauma surgery with my partner, are we co-surgeons or assistant surgeons?
    • What about if we repair different organs?
    • What if one leaves before the case is over?
    • Multiple trauma with a different specialist: Are we co-surgeons or assistant surgeons? Or do we all bill our own work?
  • Payor expectations for co-surgeon and assistant surgeon documentation
  • Reimbursement: Difference between co-surgeon or assistant surgeon

Modifiers in Trauma Surgery

  • Is there a modifier that reflects the time and effort to do a complete trauma laparotomy? What can I bill for removing a bell full of blood to discover what exactly is injured?
  • Will modifier 22 work on the majority of my surgeries because all take extra time and intensity? How often can I append this in trauma? Will it get paid?
  • Modifier use in damage control surgery. What is used on the first surgery? What about on the second or third? Will all be paid?
  • Repairing several organs, liver, diaphragm, large and small bowel, or more. Will all get paid and which modifiers are needed? What is unbundling okay?

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: When is a subsequent encounter not a subsequent encounter?

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, trauma Whipple, fasciotomies, damage control surgery, wound vac coding, pre-peritoneal packing, reporting multiple trauma
  • 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?
  • New definitions for extensive undermining
  • 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
  • Defining organ system failure: Dissecting critical care criteria

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 and Place of Service: Where Can Critical Care Be Reported

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

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

Documenting Critical Care

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

Teaching Physicians and Critical Care: Billing Imperatives

Billing Critical Care for Nurse Practitioners and Physician Assistants