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