5 coding and billing mistakes that reduce trauma center revenue

Authored by Angie Chisolm, MBA, BSN, RN, CFRN, TCRN. As published by Trauma System News, June 19, 2019. 

When coding and billing are optimized, most trauma programs can become a key driver of hospital financial performance. Philips Blue Jay Consulting’s Angie Chisolm explains. 

Too many trauma programs are clinically strong but financially troubled. When this happens, hospital leaders may consider downgrading their trauma designation or even closing their trauma center. 

In my experience, this is usually unnecessary. The real problem is that no one in the hospital is an expert in trauma coding and billing. Often hospitals don’t even pursue reimbursement beyond the DRG payment. As a result, the trauma program misses out on legitimate reimbursement opportunities. 

While trauma center coding and billing are unique, they can be mastered with some attention from management. The first step is to understand the following five mistakes. 

1. Failing to register trauma patients as type 5

This is a basic issue, but we see this mistake fairly often. In order to bill for a trauma activation, the patient must be registered as Field Locator (FL) 14 patient type 5. Unfortunately, hospital registration staff frequently miss this code. In some cases, this is because staff members do not understand how this code should be used. In other cases, however, type 5 is not even turned on as an option within the registration system. 

To determine whether your staff are consistently capturing type 5 patients:

• Run a report from the trauma registry on all trauma activations for the month.
• Run a second report from the hospital’s registration database on all type 5 patients. 
• Cross-reference the reports to identify patients who received a trauma activation but were not assigned a type 5 code.

Performing this validation monthly will ensure all trauma patients are being consistently and appropriately registered. This process will also identify any non-activation patients who may have mistakenly been coded as type 5. 

2. Only considering physician time when billing for critical care

In order to bill the Center for Medicare & Medicaid Services (CMS) for a trauma activation, a patient must have received at least 30 minutes of critical care (CPT 99291). In some trauma centers, coders interpret this to mean 30 minutes of physician critical care. This is a mistake. 

• The Outpatient Prospective Payment System (OPPS) specifies that critical care time includes time that a physician and/or hospital staff are engaged in active face-to-face care of a critically ill or critically injured patient. 
• In addition, this time can be sequential or interrupted, as long as the total is 30 minutes or more. 

To accurately capture critical care time for the entire trauma team, make sure scribing nurses record start times (patient arrival) and stop times (disposition after 30 minutes) consistently. Vital signs should be documented following your hospital’s standard critical care documentation policy or as appropriate for patient need.

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