Inappropriate Trauma Activation Charges

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A common theme appearing all across the country is the tendency for hospitals to bill a trauma activation fee, ranging from $6,000 to $30,000, for all patients whose injuries arise from a motor vehicle accident, no matter how minor the accident or injuries. These charges appear even when the patient is triaged by a nurse, examined by one physician and discharged to home after two or three hours.

Just what is the trauma team and how do trauma services work?
 
The trauma team is a group of doctors (generally an ER physician, a general surgeon and an orthopedic surgeon), nurses, operating department assistants, anesthesiologists, radiology technician, phlebotomist, respiratory therapist and other support personnel who have no other commitment while on duty than to receive and treat trauma patients. Other types of physicians such as a neurosurgeon, thoracic surgeon, and plastic surgeon, while not involved in every trauma call, need to be available to the trauma team immediately.
 
The core trauma team is comprised of several people working around a single patient, with the entire trauma process being directed by a trauma team leader. Essentially, the trauma team is an efficient machine; each member knowing his or her place and tasks, and each having the skills, equipment, and support to accomplish those tasks.  
 
So back to the question…was activation of the trauma team appropriate?  
 
Trauma activation is initiated by the pre-hospital caregivers, or paramedics on the ambulance crew.  At the scene a motor vehicle accident, the emergency providers must determine the severity of the injury and initiate medical management through a process called field triage.
 
The National Trauma Triage Protocol was established by the U.S. Department of Health and Human Services Centers for Disease Control and Prevention.  First responders and ambulance personnel must assess that the patient meets thses field triage criteria in order to activate the trauma, and notification must be made to the hospital prior to the patient’s arrival. Trauma activation can only occur based on receipt of the field triage information. The documentation from the ambulance staff and from the trauma center must reflect that, during an emergency medical call, the paramedic has been in constant phone contact with a hospital emergency room physician. The paramedic and the physician pair together in making critical life care decisions.  
 
Should you pay for the trauma activation; was it billed correctly?  
 
Trauma team services are billed with HCPCS code G0390. This code is defined as “trauma services associated with critical care services.” According to coding guidelines set forth by the Center for Medicare and Medicaid Services, 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.  
 
If the hospital activates the trauma team, the records must reflect that the trauma triage protocol was met at the scene, and that the ambulance team initiated the trauma services and was in constant contact with the facility. If trauma services are billed for, with HCPCS code G0390, the clinical notes must reflect that critical services were provided and the invoice must include a charge for these services, billed with CPT code 99291.



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