*agenda subject to change
7:00AM — 8:00AM
Check-in and Breakfast (provided)
1 hour 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?
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?
9:45AM – 10:00AM
Trauma Procedure Coding
- Central venous catheters with imaging
- Emergent procedures
- Chest tube
- Intubation, tracheostomy
- Pericardial window
- tPA in chest tubes
- Wound exploration
- 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
- 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
12:00PM — 1:00PM
Wound Repair Coding: Do’s 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
2:45PM — 3:00PM
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?
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
Documenting Critical Care
- Supporting documentation: What justifies medical necessity and what does not?
- Examples of acceptable and unacceptable critical are documentation
- Critical care scenarios