E420 premium for traumas


We recently audited the billings for trauma patients that the ED is involved with that went on to TTL activation. We pulled the PIN from all the patients in 2010 that had a severe enough injury to warrant the Trauma Premium code E420. This involves patients with an Injury Severity Score (ISS) of >15.A patient with 3 rib fractures, a displaced ankle fracture, and a long facial laceration would have an ISS>15 as an example.

The score looks at the 3 most injured body region. 3 moderately injured body regions quickly adds up to 16 or more.The result was that we are terrible at noting this code as only about 5% of the charts that deserved the code had it billed. This code provides a 50% premium on all resuscitation codes and procedures done in the ER. It can be applied to each ED doc involved in the care. This is potentially hundreds of dollars per patient. There are few patients that warrant this code, however, it is an easy way to bill a big ticket billing code.An estimate would be that this code is applicable about 9 times a month.This severity score, although not difficult to calculate, is often difficult for the ED to know as the extent of all the injuries is not known in the trauma bay. Hence it is difficult for us to know their score early on. In an attempt to gather these E420 codes, Trauma services has provided us with a list of the patients that were initially managed in the London EDs that went on to TTL activation, and had an ISS >15. We pulled the charts of these patients from the last half of 2010 and resubmitted the E420 code. The first batch were paid, the second half rejected. Despite communications and explanations, they will continue to be rejected if the E420 code is not submitted at the time of the initial billing submission. Therefore, we need a mechanism for the billing staff to recognize that these charts should not be submitted until the ISS score is known. Hence I propose the following: [B]Flag on the Blue sheet “Trauma” or “E420” Which patients? [/B]

[B]Any patient arriving for TTL from another centre in which you provided any care (also write a quick note & include your G3 or G5 code)Any patient in which you refer to another surgical service for a traumatic injury that has more than one body region injured[/B]

Our billing staff will see these flags and hold the chart until the ISS report comes from Trauma Services. If they meet the criteria, the E420 code will be added at the time of initial submission.

You do not need to calculate the score. Just flag it with “Trauma” or “E420” on the blue sheet!