Question trauma activation

ladymatthew

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question: I have a facility that is a registered level 1 trauma center trying to bill trauma activation for a patient along with EM 99282. The patient came in via amb (should have charged 99283) with a knee and head complaint after fall from a ladder. There was no trauma physician present on arrival..... only ER physician nurse and imaging staff. It was indicated on the trauma flow sheet that prehospital notification was given at 1225 and the ETA was 2 minutes and the arrival time was 1225. That didnt make much sense but anyhow...... they are billing rev code 681 because they are a registered Trauma I center however it just doesnt seem like the charge is substantiated. Please help
 

samijo71

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Hello so sorry this is so late but hope this helps. We have had a lot of issues with this in our facility. I found this information very useful.

This was from HCPro in 2010 but as far as I know they have not updated anything since.
Tip: Learn the requirements for trauma
activation
APCs Insider, August 6, 2010
Several conditions must apply before CMS will pay the trauma activation fee. First, the trauma center must
be designated or licensed by a state or local government authority or must be verified by the American
College of Surgeons (ACS).
ACS verification is designed to assist hospitals in the evaluation and improvement of trauma care. It also
helps provide information about the trauma system’s capacity to function, its performance, and its trauma
system development. Verified trauma centers must meet criteria described in ACS’ “Resources for Optimal
Care of the Injured Patient.”
Second, trauma team activation or notification of key hospital personnel must occur based on receipt of
triage information. Without this pre-hospital notification, you may not bill for trauma activation.
Third, the hospital must bill for critical care services. Report CPT codes 99291 (critical care, evaluation
and management of the critically ill or critically injured patient, at least 30 minutes, for the first 30–74
minutes) and 99292 (for each additional 30 minutes) when appropriate.
 
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