President's Message

Written by: Kimberly A. Davis, MD, MBA

Thank you to all our members and guests who attended the 84^th Annual Meeting in Boston – our attendance was truly memorable! Congratulations to Dr. Nirula and the entire Program Committee for organizing an enjoyable and educational event. There were many highlights, including the incredible Fitts Oration by Dr. Brian Eastridge titled “Forged in the crucible of life and death: Build upon legacy and bound by mission.” His speech was a compelling and inspiring tribute to our military members and their sacrifices in service to our country. Other notable moments included Dr. Ronny Stewart’s Presidential Address on lessons learned from trauma system development and the panel session on the development of NTEPS. It was an exceptionally successful meeting, and I thank everyone who contributed to its creation and execution.

As we anticipate the coming year, there is much work ahead. All our committees are busy with new and ongoing projects. Thankfully, this year we welcomed more than 75 new Fellows and 87 Associate Members into the organization. Additionally, we successfully placed over 90 members in new committee positions. Three new committee chairs were appointed including Mitch Cohen (Scholarship), Bindi Naik-Mathuria (Pediatric Trauma) and Shannon Foster (Communications). If you volunteered, you were assigned to a committee. We look forward to your participation in the organization. Feedback and input from our members make us a stronger, more cohesive organization. 

As I am sure you will hear from Suresh Agarwal, our REF Chair, we had a very successful auction at the banquet. We sincerely appreciate our members' generosity in supporting the REF. Strengthening and augmenting the research engine of the organization's  is one of my main priorities for the upcoming year, and I have great faith in our committee chairs and their ability to facilitate this goal, including  Mitch Cohen (inaugural Scholarship Chair) and Kevin Schuster (MIT). More details will come soon, as they have some exciting ideas to share.

In other news, we welcome our third class to the Leadership Academy, led by Bellal Joseph, and celebrate the ongoing success of the ROBO-TRACS course under Matt Martin's leadership. More updates on future educational offerings to come… 

Finally, I am incredibly grateful to Sharon Gautschy and the outstanding AAST staff who make all our work possible. We are fortunate to have such a talented team that consistently works behind the scenes to keep our projects moving forward. Please remember to thank them during your committee conference calls... chances are they planned them! And from me, a personal thank you for the honor of serving as your President for the upcoming year.

My best,
Kim

Associate Membership Chair Message

Written By: Brittany Bankhead, MD, MS, FACS

What an incredible time we had at this year’s AAST Annual Meeting! It was energizing to connect with so many Associate Members in person, and the excitement surrounding the Associate Member community was truly palpable. Our group celebrated both the most well-attended business meeting and happy hour in our history — a clear reflection of the enthusiasm, ideas, and camaraderie that make this organization so special.

As we move into fall, one of our headline initiatives is The Sounding Board, a new mentorship program designed to provide focused, high-impact guidance for members at all stages of their careers. This effort grew directly from a member-wide survey that highlighted a strong desire for senior mentorship in research and professional development. Sign-ups will be offered quarterly to allow new mentor-mentee pairings. You can learn more and sign up on the website.

Beyond the Sounding Board, there are many ways to stay connected and involved. Our WhatsApp groups remain active spaces for sharing everything from clinical questions and research opportunities to parenting tips and cooking ideas — a true reflection of how multidimensional and supportive this community is. And if you’re interested in contributing but unsure where to start, reach out to one of our committee chairs. There are always ad hoc projects and initiatives where your expertise and enthusiasm are welcome.

We’re grateful for the energy, collaboration, and innovation that Associate Members bring to the AAST, and to the Board of Managers for their continued support and guidance in helping shape the next generation of trauma surgeons. 

Brittany Bankhead, MD, MS, FACS
Chair, AAST Associate Membership

Multi-Institutional Trials Committee

Announcing the Sounding Board: A New Mentorship Initiative

Written By: Navpreet K. Dhillon, Kevin Schuster, and Mayur Patel

This summer, a member-wide survey of AAST highlighted a clear theme: trainees (resident, fellow), junior faculty, and mid-career faculty are eager for senior mentorship in research and professional development.

In response, the Associate Member Council and the Multicenter Trials Committee have launched the Sounding Board: brief, high-impact mentorship sessions designed to engage on topics in research and professional development.

Through the program, interested AAST members (of any category) are matched with one or two senior AAST members for a single focused, one-hour mentorship session. Conversations may cover a broad range of topics—from developing a research niche or refining a study to topics in professional development, such as navigating career transitions and trajectories. Mentees will provide a brief report to the AAST following each session to share insights from their experience.

Sign-ups will be announced quarterly to create new mentor-mentee pairings. This is a great opportunity to interface with a senior member of the AAST and have a focused discussion around a topic of your preference.

Senior and experienced AAST members are critical to the success of this initiative – please consider serving as a Mentor!

Please visit the Sounding Board website here.

Questions may be directed to Dr. Navpreet Dhillon at [email protected].

Healthcare Economics Committee

Healthcare Economics Update

Contributing Author: Parker Hu, MD, FACS
Managing Editors: Raeanna Adams, MD, MBA, FACS; Samir Fahkry, MD, FACS

Telemedicine

Unfortunately, the telemedicine waiver present during the pandemic has now expired and there was no successful legislative Continuing Resolution to extend the conditions. As of October 1, 2025, we must adapt to the former criteria for reimbursement. Mental health services will still be covered, regardless of originating site, but will return to requiring an in-person followup within 6 months. Patients receiving other covered telehealth services must once again be at an approved originating site of a rural area, as defined by the Center for Medicare Services (CMS).

Correctly Combining Codes for Procedures on Same Date

Basic Rules

CMS created the National Correct Coding Initiative (NCCI) to prevent payment of services that should not be reported together. This prevents payments for overlapping services except where “separate and distinct.”

• In general, providers must report:
  • Services correctly without either upcoding or downcoding.
  • The most comprehensive service.
  • Complete procedural codes, not separate, individual fragments. In other words, services integral to a procedure cannot be separately billed. Common examples of elements that cannot be separately billed for many procedures include:
    • Incision
    • Exploration of surgical field
    • Lysis of adhesions
    • Intra-operative endoscopy when used to verify operation performed correctly without injury/leak
    • Cultures
    • Insertion of drains
    • Closure
  • A single approach for procedure
    • Multiple approaches for same procedure are mutually exclusive.
    • In other words, if an initial approach fails (i.e. laparoscopic converted to open), only the completed approach to procedure may be reported (in this example, only the open procedure can be billed)
    • Conversion to open from a laparoscopic approach cannot be billed as separate diagnostic laparoscopy
  • A single complexity for a procedure, unless at different anatomic locations or encounters

NCCI Modifers

CPT modifiers can facilitate reimbursement for multiple codes when appropriate. Use of these modifiers during the same encounter should only be for procedures not ordinarily performed on the same day. Use can’t be described by a more specific modifier.

• Modifier -58: Staged or Related Procedure During Postoperative Period
  • If second procedure was:
    • Planned prospectively
    • More extensive than first procedure
    • Performed after a separate diagnostic procedure
      • Diagnostic endoscopic procedure leading to open operation may both be reported with -58.
        • However, diagnostic endoscopy may never be combined with another endoscopic procedure in same organ/region.
        • Similarly, diagnostic laparoscopy may not be combined with another laparoscopic or, if converted, open operation
• Modifier -59: Separate and Distinct Services
  • Indicates a procedure was distinct or independent from other procedural services performed on the same day.
  • Documentation must support that services are distinct and appropriate due to:
    • A different session,
      • Eg. Resuscitative thoracotomy in ER then later laparotomy in OR
    • A different procedure or surgery,
      • Eg. Splenectomy and concurrent right hemicolectomy
      • NOT cecectomy and right hemicolectomy
    • A different site or organ system,
      • Eg. Multiple different areas of bowel requiring separate repair/resection
      • NOT anterior and posterior injuries of one segment of bowel
    • A different incision,
      • Eg. Patient with both thoracotomy and laparotomy
    • Or a separate injury
  • Similar, more specific modifiers are also available and should be used if possible:
    • XE: separate encounter - a service that is distinct because it occurred during a separate encounter
    • XP: separate practitioner - a service that is distinct because it was performed by a different practitioner
    • XS: separate structure - a service that is distinct because it was performed on a separate organ/structure
    • XU: unusual non-overlapping service - the use of a service that is distinct because it does not overlap usual components of the main service
• Modifier -78: Unplanned Return to Operating Room for Related Procedure
  • Complication requiring return to OR during the global period of initial operation
• Modifier -50: Bilateral Procedures
  • Second procedure occurs during same session on opposite side 
• Modifier -51: Multiple Procedures
  • Used to indicate that multiple procedures were performed by the same provider during the same session
  • If two procedures are distinct and not bundled by NCCI.
  • Should not append to add-on codes (designated by “+” sign)
  • Typically reimbursed 100% of allowable amount for primary procedure and reduced rate for subsequent procedures. 
  • No longer required by Medicare and some other payors.

References

1. Medicare payment policy. Telehealth.HHS.gov. May 29, 2025. https://telehealth.hhs.gov/providers/billing-and-reimbursement/medicare-payment-policies
2. Telehealth & Remote Patient Monitoring. Medicare Learning Network MLN901705. April 20, 2025. https://www.cms.gov/files/document/mln901705-telehealth-remote-patient-monitoring.pdf 
3. NCCI Policy Manual for Medicare Services. Chapter 1 – General Correct Coding Policies. Revision Date (Medicare): 2/28/2025. https://www.cms.gov/files/document/01-chapter1-ncci-medicare-policy-manual-2025finalcleanpdf.pdf
4. Proper Use of Modifiers 59, XE, XP, XS, & XU. Medicare Learning Network. MLN1783722 February 2025. https://www.cms.gov/files/document/proper-use-modifiers-59-xe-xp-xs-xu.pdf

Palliative Care Committee

Entrusting Compassion: Teaching Primary Palliative Care in Trauma Education

Written By: Mackenzie Cook, MD

Every acute care surgeon can recall the moments that linger long after the operative dictation is signed: a family meeting in the ICU at 2am, the conversation where recovery slips out of reach, the silence after delivering news that a loved one has died. These discussions define our practice as much as hemorrhage control and complex critical care, yet most of us were never formally taught how to manage them. We learned by watching, by stumbling, and by improvising in real time. That approach is not good enough for the next generation.

The educational community is beginning to catch up. The newest edition of ATLS includes an entire chapter on communicating serious news in the acute setting, signaling that communication belongs alongside airway, breathing, and circulation in the trauma surgeon’s toolkit. TQIP guidelines explicitly call for trauma teams to provide primary palliative care, recognizing that timely involvement improves quality of care. The Fundamentals of Communication in Surgery curriculum, developed by Dr. Schwarze and colleagues at the Wisconsin Patient Preferences Project, is being piloted, offering an evidence-based roadmap for building these skills. The message is clear: communication and palliative care are essential competencies of acute care surgery.

We already know how to teach complex, high-stakes skills. We scaffold, supervise, and entrust in the operating room and trauma bay. That same logic should apply to palliative care skills. Instead of waiting for a new EPA to be created, we can borrow the concept of entrustment directly; progressively giving trainees autonomy to lead goals-of-care conversations, to deliver serious news, and to manage distressing symptoms. By the end of fellowship, acute care surgeons should be fully entrusted to handle these encounters independently, just as we trust them to run an ICU or perform a trauma laparotomy.

Teaching palliative care is not easy for every surgeon. Skill varies widely, and many faculty do not have an established deliberate approach to teaching these conversations. The good news is that resources already exist. The SCORE curriculum includes modules specifically for surgical residents, and the VitalTalk group has proven that difficult conversations can be practiced through simulation. The infrastructure is in place; what remains is our desire to use it. Critically, this is not the responsibility of “the system” alone. Each of us, as individual educators, must take up the charge to incorporate palliative teaching intentionally into our daily work with partners, colleagues, students, residents and fellows.

The practical steps are straightforward. Start early and repeat often. Let interns observe and learn basic communication frameworks. By mid-residency, give them opportunities to practice in simulations or low-stakes clinical settings. By senior years, entrust them to lead conversations under direct or indirect supervision.  Challenge colleagues to view high quality primary palliative care as an essential part of our job that deserves professional development and quality assurance. In short, teach this skill like you teach all the others. Perhaps the most difficult step connects to this final point - faculty must role model these skills and demonstrate, visibly and repeatedly, that providing high quality primary palliative care is an essential part of being a high quality surgeon.

We are uniquely credible teachers of these skills for trainees as we live them daily. We sit at the intersection of sudden catastrophe and life-altering decision-making. Our trainees watch how we deliver devastating news, how we balance honesty with compassion, and how we acknowledge uncertainty while guiding a path forward. We already have the curricula, the guidelines, and the educational frameworks. What we need now is resolve.

If trauma education is to remain at the forefront of surgical training, we must expand our definition of technical mastery to include communication and compassion. By embedding palliative education into the fabric of residency and fellowship, we will graduate surgeons prepared not only to save lives, but also to guide patients and families through their hardest moments with skill and humanity.

Pediatrics Committee

What is “Peds Ready” and how can your ED get there?

Written By: Aaron R. Jensen, MD, MEd

Children have unique characteristics that require specific care, especially in emergencies. But not all children have access to specialized pediatric care. In fact, 80% of children receive emergency/trauma care in general EDs. Low pediatric patient volume can make it challenging to prioritize pediatric care.

Pediatric Readiness saves lives. Research shows that high levels of Pediatric Readiness (>87 points) are associated with:

• 76% lower mortality rate in ill children
• 60% lower mortality rate in injured children

New ACS trauma center verification for Level 1 and 2 centers requires being “Peds Ready” (National Pediatric Readiness Project assessment), which has improved readiness for these centers; however, adult only free-standing level 1/2 centers, level 3 and 4 centers and non-designated centers, which do not have these requirements in place, still lag behind.

Melhado CG et al. J Trauma Acute Care Surg. 2025 Jan 1;98(1):69-77.

The EMSC’s National Pediatric Readiness Project now has simple tools to help you help your ED/Trauma Center become Peds Ready at https://emscimprovement.center/domains/pediatric-readiness-project/

Use this checklist to check your ED’s Pediatric Readiness and identify gaps.

The website has FREE resources including checklists for peds equipment, supplies, medications, and protocols https://emscimprovement.center/domains/pediatric-readiness-project/readiness-toolkit/readiness-toolkit-checklist/

An additional useful resource by EMSC is their Pediatric Education and Advocacy Kit (PEAK) for Multisystem Trauma with guidelines (ex. imaging and MTP) and simulation modules found at https://emscimprovement.center/education-and-resources/peak/multisystem-trauma/?media=354 

Make sure your ED/Trauma Center gets that A grade (90+) and help us save kids lives, no matter where in the country they get injured.

Pediatric Committee

AAST Cutting Edge: AAST Delegation to the Kingdom of Morocco

Written By: Kristy Hawley, MD, MPH and Mary Fallat, MD

The Kingdom of Morocco hosted a delegation from the AAST to explore their country's trauma care system, medical education, and healthcare infrastructure. This meeting was initiated following a similar engagement with the American College of Surgeons (ACS) in 2022, during which the Moroccan government conveyed its interest in partnering with experts from the AAST to explore their plan to develop a comprehensive national trauma system. This delegation activity was initially scheduled in 2023; however, a large earthquake in the region prompted a delay for a year.  It also afforded the delegation the opportunity to review and learn from the response to this disaster.

The delegation, led by Dr. David H. Livingston, past President of the AAST, comprised a diverse group of trauma surgeons with expertise in trauma survivorship, pre-hospital care, trauma system development, pediatric trauma, robotic surgery and post-graduate education. Activities included meetings with Morocco’s Ministry of Health and visits to prominent teaching hospitals in Rabat, Fez, and Marrakesh. The itinerary featured visits to the Mohammed VI Hospital in Marrakesh, The Mohammed V University in Rabat, and a regional hospital, Al Ghassani in Fez. Participants discussed healthcare system goals, such as improving trauma education, emergency response, and care coordination.

Morocco's healthcare system is presently undergoing significant reform, with trauma care and injury prevention as key priorities of King Mohammed VI. The Ministry of Health espouses three pillars for trauma care: prevention, trauma system development, and strengthening rehabilitation programs. The government is working to strengthen the trauma system as part of broader healthcare reforms, including the introduction of compulsory health insurance and expanded infrastructure. Moreover, Morocco's successful bid, alongside Portugal and Spain, to host the 2030 FIFA World Cup provides additional impetus to develop its trauma system to further enhance the country's emergency response services to help manage this populous event.

The next steps between the AAST delegation and the Moroccan Ministry of Health begin with preparing and delivering a formal report. This report will outline observations, findings, and insights gained during the delegation’s visit and include actionable recommendations for developing a comprehensive trauma system in Morocco. It is hoped that this will be the start of an ongoing relationship between the AAST and the Kingdom. Additionally, opportunities have been identified for potential scholarly contributions to our trauma journals from the Moroccan healthcare system, particularly through publications highlighting their unique experiences and strategies in disaster care during the 2023 Al Haouz Earthquake.

AAST Delegation Members:

Delegation Leader: David Livingston, The University of Colorado School of Medicine
Stephanie Bonne, Advocate Health Care
Mary Fallat, University of Louisville School of Medicine
Kristy Hawley, The University of Colorado School of Medicine
Katherine Kelley, Kelley Acute Care Surgery
Ajai Malhotra, The University of Vermont
Amy Murphy, TriHealth, Cincinnati
Michelle Papathanas, TriHealth, Cincinnati
Anne Rizzo, The Guthrie Clinic

Delegation members arrive at the Moroccan Ministry of Health and Social Protection in Rabat for a high-level meeting to discuss international collaboration in health policy, surgical education and trauma system development in Morocco.

Delegation members gather in the main boardroom at the Ministry of Health. Discussions focused on trauma care advancement and trauma system development.