SATURDAY

Intensive Trauma and Critical Care Coding

Agenda

*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

Break

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
    • Thoracotomy
    • Resuscitation
    • Hemorrhage management
  • Imaging and the trauma surgeon
    • FAST exams
    • Other imaging 
  • Trauma surgery coding
    • Liver, spleen, intestine resection/repair, etc.
    • Fasciotomies
    • 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

Lunch

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

Break

3:00PM — 4:00PM

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.

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.

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