1. Who qualifies?

Trauma patients for whom there has been prehospital notification by EMS
(patients who arrive by private vehicle are NOT eligible), AND
Who meet either local, state or ACS field triage criteria OR
Who are delivered by inter-hospital transfers, AND

Who are given an organized team response

There are three levels of organized response:

Full Trauma Team Activation
Partial Trauma Team Activation
Trauma Evaluation or Consult

This information must be clearly documented.
Ideally, the triage criteria and organized responses should be
standardized corporate-wide. 

2. How will these patients be identified to third-party payers?
On the UB-92 HCFA-1450 form, FL19, a fifth patient classification has
been created:

	Type 1: Urgent
	Type 2: Emergent
	Type 3: Elective
	Type 4: Newborn
	Type 5: Trauma

3. What billing codes are assigned? On the UB-92 HCFA-1450 form,
FL42, a "68x" billing code has been established:

681: Level I Trauma Center
682: Level II Trauma Center
684: Level IV Trauma Center

Additional T21 billing codes identify the type of response.
NOTE: the 68x code is used in addition to the usual ED Level 1-5 charge. 

CPT codes have not been established. That is the next initiative.

4. The Trauma Billing Team should include:

Admitting/Registration Services (FL19, Type 5)
Financial Services (FL42, 68x)
Information Services
ED/Trauma Billing (enter charges)
Contract Management Services
Trauma Services (triage criteria, organized response definitions, documentation)

2. Monitor reimbursement closely and communicate closely with payers.
This includes appealing all denials.

3. Although Medicare and Medicaid are not yet "on board",
they should be at some point in the future.
Medicare cannot deny a bill because codes are used 
(Medicare 3604 was mentioned, but I haven't had a chance to look it up yet).

4. Consider contract carve-outs with commercial payers.

5. Routine (monthly?) financial reports for 68x patients will allow close
monitoring of payments and denials.

Submitted by Patrick Michaelis, Trauma Services Coordinator, St. Joseph Hospital, Bellingham, 98225

Questions or comments?
Contact the Trauma Service at St. Joseph Hospital