Intensive Trauma and Critical Care Coding


*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?

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?

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
    • 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


1:00PM — 1:30PM

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

1:30PM — 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
  • 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


3:00PM — 4:00PM

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?
  • 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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Coding Coaches