*agenda subject to change
7:00AM — 8:00AM
Check-in and Breakfast (provided)
8:00AM – 9:30AM
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?
Surgeon Role Modifiers
- Co-surgeon vs. Assistant: Are you reporting these correctly?
- Multiple trauma surgery with my partner, are we co- or assistant surgeons?
- Multiple trauma with a different specialist, are we co- or assistant surgeons?
- Payor expectations for co-surgery and assistant surgery documentation.
- Reimbursement: Difference between co- or assistant surgeon.
Same Day Surgical Procedure Modifiers
- Modifier 22: When is it appropriate to use a 22 and will it get paid? Does the very nature of trauma surgery make a 22 more common when you report? Will 22 be an audit flag?
- Modifier 50: Which procedures accept a bilateral modifier?
- Modifiers 52 vs. 53: What’s the difference? How is each used in trauma and general surgery. Using the 52 modifier in damage control surgery.
- Modifier 51 vs. 59: How do you know which one to use? How does reimbursement differ for each? Surgery on multiple organs: Is a 51 or 59 used?
Surgical Services Performed During the Global Surgical Period
- Modifier 58: Documenting staged procedures. Do they always need to be pre-planned? What about re-exploring and packing a liver hemorrhage while in the global period? What about damage control surgery?
- Modifier 79: What defines an unrelated procedure? Is a different diagnosis essential? Is this used when I re-open an abdomen after damage control surgery?
- Modifier 78: Does this apply to in office procedures? How do I report in-patient treatment of post-operative complications?
- How does each modifier impact reimbursement?
9:30AM – 9:45AM
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
10:00AM — 12:00PM
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.
- Damage control surgery
- Wound vac coding
- Reporting multiple trauma, what’s separately reportable
- Vessel repair and vessel ligation: Is it separately reported?
- Case scenarios
12:00PM — 1:00PM
1:00PM — 1:30PM
Wound Repair Coding: Do’s and Don’ts
- Simple, intermediate, complex repairs: When are they reported with trauma care?
- Debridement/wound care therapy: Wound vac use and reimbursement.
1:30PM — 2:45PM
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
Critical Care and Place of Service: Where can Critical Care be Reported
- ED, inpatient, ICU. Is there a difference?
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
- Physicians of the same specialty.
- Physicians of different specialties.
- Trauma surgeon and intensivists. Who bills?
- The trauma surgeon as an Intensivist. How does billing changes?
2:45PM — 3:00PM
3:00PM — 4:00PM
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.
Teaching Physicians and Critical Care: Billing Imperatives
Billing Critical Care for Nurse Practitioners and Physician Assistants
Documenting Critical Care
- Supporting Documentation: What justifies medical necessity and what does not.
- Examples of acceptable and unacceptable critical are documentation.
- Critical care scenarios.