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

Trauma and Critical Care Coding

This course goes narrow and deep into the distinct coding issues faced by trauma and critical care surgeons. In this course you will learn the granularities of the relevant global surgical packages; gain the know-how for choosing the correct modifier to report surgeon role, same-day surgical procedure, and surgical procedures performed within the global period; get all the details needed to code and document an array of procedures common in a trauma and critical care environment, including emergent procedures, abdominal trauma, damage control surgery, wound care, imaging, and vessel repair.

New in 2021, the critical care section has been expanded to include case scenarios that will help you identify which critical care circumstances support critical care reporting and how to create documentation that will withstand scrutiny. This course also describes when resident or NP/PA documentation and time count in your critical care calculation.

The ACS designates this on-demand enduring activity for a maximum of 6 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Of the AMA PRA Category 1 Credits™ listed above, a maximum of 6 credits meet the requirements for Self-Assessment.

Register now for this on-demand course!

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
  • 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? 
  • 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? When is unbundling okay?

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

Trauma Surgery Coding

  • Reporting multiple trauma: What’s separately reportable? Liver, spleen, intestine resection/repair, etc.: Is it billable? 
  • Pre-peritoneal packing 
  • Damage control surgery 
  • Wound vac coding 
  • New! Trauma Whipple: Billing for venous reconstruction 
  • Fasciotomies 
  • Vessel repair and vessel ligation: Is it separately reported 
  • New! 2020 Codes for vessel exploration 
  • 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

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?