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

Trauma and Critical Care Coding

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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