Trauma Activation- Facility Services
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Defines when trauma activation billing is appropriate for designated trauma centers, revenue codes and related billing/coding guidance, and how critical care and ED services may be reported in conjunction with trauma activation. Affects facilities (hospitals/designated trauma centers) submitting claims to Blue Cross Blue Shield of Illinois.
No material clinical or coverage changes in this revision.
When Trauma Activation Billing Is Appropriate
Trauma activation billing and reporting criteria
When trauma activation billing is appropriate and how to report associated services:
ALL of the following
- Facility must have received pre-arrival notification from a pre-hospital caregiver (e.g., EMS) to bill revenue code O68X and FL 14 Type of Admission/Visit code 05; if the patient walks in or is driven without notification, O68X should not be billed (the member may still be classified as trauma for follow-up using FL 14 Type 05).
Cite NUBC guidance for pre-arrival requirement.
ALL of the following
- Only designated trauma centers or hospitals may submit revenue code O68X; non-designated centers must not use FL 14 Type 05 or O68X when billing for trauma services.
Revenue code O68X restricted to designated centers per ACS/state designation guidance.
ALL of the following
- The specific revenue code within O68X (0681-0684, 0689) is determined by the activation level and should not exceed the facility’s designated trauma level (e.g., a Level II center may not bill a Level I activation).
Select revenue code consistent with facility ACS designation and activation level.
Highest level activation minimal criteria
- Confirmed systolic blood pressure <90 mm Hg in adults (age-specific hypotension for children).
- Respiratory compromise, obstruction, or intubation.
- Use of blood products to maintain vital signs in patients transferred from other hospitals.
- Discretion of the emergency physician.
- Gunshot wounds to abdomen, neck, chest, or extremities proximal to the elbow or knee.
- Glasgow Coma Scale <9 with mechanism attributed to trauma.
ALL of the following
- If critical care administered is less than 30 minutes when trauma activation occurs, the facility may report charges under revenue code(s) O68X but should not report HCPCS G0390.
ALL of the following
- Emergency department level(s) of care may be billed in addition to trauma activation on the same claim; revenue codes 045X (ED) and O68X are not bundled and may appear together when appropriate.
Revenue, CPT and HCPCS Codes for Trauma Activation
| O68X (0681-0684,0689) | Revenue codes for trauma response levels (0681-0684, 0689 other trauma response). |
| G0390 | HCPCS — Trauma response team (one unit when billing with ≥30 minutes critical care). |
| 99291 | CPT — Critical care physician services (reportable with trauma activation when ≥30 minutes). |
| 045X | Emergency department revenue codes — may be billed in addition to trauma activation on same claim (not bundled with 068X). |
Documentation and Policy Governance Responsibilities
Documentation Requests and Provider Responsibility
Providers are responsible for submission of accurate documentation of services performed. The Plan may request supporting documentation and providers are urged to submit any additional records upon request to substantiate billed services. Claims are subject to code edit protocols and claim review, which may include review of benefit coverage, provider contract language, medical policies, clinical payment and coding policies, and coding software logic. Failure to adhere to coding and billing policies, or to provide requested documentation, may impact claims processing and reimbursement.
- Submit claims using valid code combinations from HIPAA-approved code sets (CPT, HCPCS, ICD-10, NDC, etc.).
- Code claims according to industry standard coding guidelines (Uniform Billing Editor, AMA CPT guidance, CMS NCCI edits, DRG rules, CMS manuals, etc.).
- Provide requested supporting documentation promptly when the Plan requests it.
- Contact the Plan for questions about trauma activation or trauma-related procedure billing.
Policy Governance
When a conflict exists between this Clinical Payment and Coding Policy and any plan document under which a member is entitled to Covered Services, the plan document will govern. When a conflict exists between this policy and any provider contract pursuant to which a provider participates in and/or provides Covered Services, the provider contract will govern. "Plan documents" include, but are not limited to, Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents. Blue Cross and Blue Shield of Illinois may exercise reasonable discretion in interpreting and applying this policy in particular cases and retains full and final discretionary authority for interpretation and application to the extent provided under any applicable plan documents.
- Plan documents govern over this policy when inconsistent.
- Provider contracts govern over this policy when inconsistent with the contract terms.
- BCBSIL may interpret and apply this policy as necessary within the scope of applicable plan documents and contractual provisions.
Key Definitions
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