Some charts may be eligible for the Trauma premium. Please see the definition/requirements below (or reference the Schedule of Benefits – General Preamble 68).
Because this code requires the Injury Severity Score (ISS), and the ISS isn’t always known at the time of service, please just write TRAUMA beside your billing codes in the lower right hand corner of the chart. This will flag us and/or Trillium to follow-up with the Trauma Office and find out the ISS.
Note that this premium cannot be added on post submission to the Ministry of Health.
Thanks
TRAUMA PREMIUM
Definition/Required elements of service:
The trauma premium is payable for each of the services and units described below when:
a. rendered either on the day of the trauma or within 24 hours of the trauma; and
b. for trauma patients age 16 or more who have an Injury Severity Score (ISS) of greater than 15, or for patients less than age 16 who have an Injury Severity Score of greater than 12.
E420 Trauma premium …add 50%
Payment rules:
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The premium is applicable to the following services and units;
a. services listed in the Consultation and Visits Section (Section A of the Schedule);
b. services listed in the Obstetrics Section (Section K of the Schedule);
c. services listed in the Surgical Procedures section (Section M through Z of the Schedule);
d. the following resuscitative services: G395, G391, G521, G522 and G523.
e. basic and time units provided by surgical assistants; or
f. basic and time units provided by anaesthesiologists. -
The premium is payable only for the services for which the medical record lists the ISS score.