Trauma Billing Codes Update (PDF 75kb)
The following is a clarified summary of some aspects of the new 68x trauma revenue code from the National Uniform Billing Committee.
The Trauma patient type went into effect on April 1, 2002, however there has been no AHA or CMS (new name for HCFA) announcement and only a few of the software vendors have upgraded their software to make the entry of the Type 5 - "trauma" possible.
The new 68x revenue code will go into effect October 1, 2002. There will be a nationwide educational program by the TRN, AHA, and HFMA to let all hospital financial personnel understand how this works. The trauma revenue codes established are 681 for Level I, 682 for Level II, 683 for Level III, and 684 for Level IV trauma centers/hospitals. There is a 689 which has not been defined. These codes are only to be used by trauma hospitals designated/categorized by a local or State agency with the legal authority to do so or verified by the ACS.
Within each code, the trauma center can establish up to three levels of activation: Full trauma team (99291), partial trauma team (99285), and trauma evaluation for non-EMS patients, transfers, etc. for whom a small team is activated (99284). Documentation is essential that proves that the team members required for each level of activation are notified and respond in the time established by policy/protocol.
Only patients for whom there has been PRE-HOSPITAL notification, who meet either local, state or ACS field triage criteria, or are delivered by inter-hospital transfers, and are given the appropriate team response, can have the activation fee charge. Patients who are "drive-by" or arrive without notification cannot be charged for activations, but can be classified as trauma under patient type - “trauma” for statistical and follow-up purposes.
At this time, only commercial and liability insurance will consider these charges. A future TRN initiative will request that CMS establish a payment schedule for trauma activation fees. Managed care payers will only pay these charges if they have a contract that "carves out" trauma.
Please watch for future updates. The AHA-NUBC is compiling a list of Frequently Asked Questions to help others understand how this charge process will work.