Intensive Trauma and Critical Care Coding


*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?

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?

9:45AM – 10:00AM


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

12:00PM — 1:00PM


30 minutes

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


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

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

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