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2021 ACS

Intensive Trauma and Critical Care Coding


  • Learn at your own pace. Start and stop when it is convenient for you.
  • With travel limitations, this is a great option.
  • Earn 6.0 CME and 6.5 CEU credit hours with the completion of an online test.
  • Receive the same great workbook and alumni resources.


Course Information

A full day devoted to trauma surgery and critical care coding! You asked for it—we’re delivering it. This information-packed course goes narrow and deep into the distinct coding issues faced by trauma and critical care providers: 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; and get all of the details needed to code and document an array of common procedures in a trauma and critical care environment, including: emergent procedures, abdominal and thoracic trauma, damage control surgery, wound care, imaging, and vessel repair.

This year, we’ve expanded the critical care section to almost an entire afternoon that will leave you confident about your critical care documentation and coding. Case scenarios will help you identify which critical care circumstances support critical care reporting and how to create documentation that will hold up under scrutiny.

We’ll also describe when resident or NP/PA documentation and time count in your critical care calculation.

This course connects clinical procedures to the selection of CPT codes, making it ideal for surgeons and coding staff.

Learning Objectives

  • Describe the global surgical package and what is separately reported for trauma and critical care services
  • Distinguish documentation for co-surgeon versus an 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
  • 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

Intensive Trauma and Critical Care Coding​

ACS Member: $695

Non-member: $845 

2021 AAPC Accreditation

This program has the prior approval of AAPC for 6.5 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor. 

Credit is available after completion of an evaluation and a 40 question test.

AMA PRA Category 1 Credits™

The American College of Surgeons designates this enduring activity for a maximum of 6.0 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 6.0 credits meet the requirements for Self-Assessment.

Workbook shipping is included in the price for addresses in the contiguous United States and takes approximately 5 business days*.

For shipping outside of the contiguous US, including Hawaii and Alaska, please email education@karenzupko.com for an estimated shipping cost and timeframe. Please be sure that you provide the correct shipping address at registration, there will be a space to enter the address if different than that of the payment address.

We strongly encourage you to wait to begin your course until your workbook has arrived.

*With congestion due to COVID-19, deliveries by Fed Ex and UPS are subject to delay. 

After registering you will receive an initial confirmation with details for the workshop. Additionally, you will receive an email with login instructions. This is necessary to participate in the workshop. Check your spam folder in case the email is directed to that folder.

It is important that you provide the email address of the person who will be participating in the event. Each separate participant requires a unique email address.

*You will have access to the content for 30 days from the time you receive the access information. Please email education@karenzupko.com if you have questions.

Once you receive your login information you can test your connection on the device you will be using for the on-demand workshop. 

The workshop content is copyrighted property of KarenZupko & Associates, Inc.  Any rebroadcast, reproduction, or other use of the pictures, content and accounts of this workshop or the accompanying workbook without the express written consent of KarenZupko & Associates, Inc. is prohibited.


*agenda subject to change


3 hours 30 minutes

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- and Assistant Surgeon

  • Co-Surgeon vs. Assistant: Are you reporting these correctly?
    • Multiple trauma surgery with my partner, are we co- 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- or assistant surgeons? or do we all bill our own work?
  • Payor expectations for co-surgery and assistant surgery documentation
  • Reimbursement: difference between co- 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 belly 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? the 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 ok?

15 minutes

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?

15 minutes


2 hours

Trauma Procedure Coding

  • Central venous catheters with imaging
  • 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, etc.
    • New! Trauma Whipple: billing for venous reconstruction
    • Fasciotomies
    • Damage control surgery
    • Wound vac coding
    • Pre-peritoneal packing: Is it billable?
    • Reporting multiple trauma: What’s separately reportable?
  • Vessel repair and vessel ligation: Is it separately reported?
  • Case scenarios


3 hours 30 minutes

Wound Repair Coding: Dos and Don’ts

  • Simple, intermediate, complex repairs: When are they reported with trauma care?
  • New! Defining extensive undermining
  • Debridement/wound care therapy: wound VAC use and reimbursement

1 hour 15 minutes

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

15 minutes


1 hour

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 and burn cases
  • In other scenarios
  • Applying E/M modifiers
  • In trauma and burn 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 are 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?

course adjourn

Complete Evaluation


On-Demand Workshop

If you have questions about the on-demand workshop or need assistance registering please email education@karenzupko.com


Consultant - Teri Romano

Teri Romano


Consultant and Speaker

Across the 3 courses 99% of participants agreed or strongly agreed
that they would recommend the courses to a colleague.


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