Kelly Posted Thu 14th of September, 2017 13:43:55 PM
Can you provide guidelines that state when(at what time) a trauma activation fee can be charged to a patient? What is the criteria used to determine if hospitals can charge for Trauma Activation? Specifically, can G0390 be charged when pre-notification is received or do hospitals have to actually non only have pre-notification , but do they also have to activate their trauma team and have them in the room working on the patient? This topic is causing a lot of disagreement at my site as some believe only pre-notification is needed. I looked at NUBC guidelines Pub 100-04, Chap 25, 75.3 and that is not what I am looking for. Hoping you can help! Thank you!
SuperCoder Answered Fri 15th of September, 2017 09:11:14 AM
Kelly Posted Mon 18th of September, 2017 12:58:23 PM
Based on your response, I have a follow-up question. Would a hospital charge the G0390 if pre-hospital notification was received but the 'trauma team' did not come gather in the ED until 30 minutes after the patient arrived in the ED?
SuperCoder Answered Tue 19th of September, 2017 02:50:22 AM
According to coding guidelines set forth by the CMS for Cpt code G0390, when trauma response team activation occurs and the hospital provides at least 30 minutes of critical care services, the invoice must also include a charge for the critical care, billed with CPT code 99291.
Hospitals that provide less than 30 minutes of critical care when a trauma activation occurs should bill for an emergency department visit, billed with the appropriate emergency examination CPT code, and may not bill with HCPCS code G0390.
Hope this helps!
Kelly Posted Wed 20th of September, 2017 08:46:45 AM
I understand how and when to charge for Critical Care. My question is specific to G0390. The information you have referenced clarifies what Trauma Activation is, and the clinical criteria used to determine if the case is a trauma, but I still need to know if G0390 can be charged ONLY when a pre-notification is received by the ED. In order to charge G0390, must pre-notification occur AND the trauma team convene and actively works on the patient?
SuperCoder Answered Thu 21st of September, 2017 05:40:09 AM
G0390 can be charged ONLY when a pre-notification is received by the ED.....Yes! Revenue code 068X is the Trauma Response Code require pre-hospital notification criteria only required to bill G0390. Hence pre-hospital notification is required.
In order to charge G0390, must pre-notification occur AND the trauma team convene and actively works on the patient?
Yes, pre notification along with trauma team convene is also required to bill G0390.
Hope this helps!
Kelly Posted Thu 21st of September, 2017 15:30:02 PM
Do you have regulations/guidelines you can refer to that specifically supports this statement?
"...Yes, pre notification along with trauma team convene is also required to bill G0390."
I have to provide proof that we cannot bill G0390 if we only receive pre-notification without the trauma team convening.
SuperCoder Answered Tue 26th of September, 2017 00:46:22 AM
Since january 1, 2007, CMS has collaborated HCPCS code G0390 with Critical Care code 99291. If Trauma response team activation associated with hospital critical care service for more than 30 minutes, you should report G0390 & 99291. But if, Trauma response team activation associated with hospital critical care service for less than 30 minutes, you cannot report G0390 and 99291, you can only report emergency department visit.
For more understanding, read pg #12-13 on Link: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/mm5438.pdf
Hope this answer your question.