title: Survey of national usage of trauma response charge codes: an opportunity for enhanced trauma center revenue.
abstract: BACKGROUND
  The objective of this study was to survey Trauma Center (TC) members of the National Foundation for Trauma Care/Trauma Center Association of America to determine usage and consistency of trauma team response charge codes and critical care accommodation charges for severely injured patients. Potential over- and underutilization of these enhanced reimbursements was assessed.
  
  
  METHODS
  All TC members of the National Foundation for Trauma Care/Trauma Center Association of America were surveyed (2007) on usage of codes Universal Billing (UB) 68x; Field Locator (FL) 19 (now FL 14) patient type 5 "TC," UB 208 and Centers for Medicare and Medicaid Services codes G0390 and Ancillary Procedure Codes 0618. Data were collected on the use of 68x "Trauma Response" in combination with emergency room UB 450 Healthcare Common Procedure Coding System Critical Care E/M Level of Service 99291, as well as the daily accommodation (bed) charge code 208 for trauma critical care.
  
  
  RESULTS
  We received 57 responses of 217 requests (response rate, 26.3%). Most responding TCs are charging for either full (86%) or partial (79%) trauma activation. Fewer are charging for trauma team evaluation fees (51%) and UB 208, trauma critical care accommodation code (33%). Charges are extremely variable between and across TC levels and among regions. Full trauma activation fees ranged from $837 to $24,964 with level II TCs charging more on average than level I TCs. As many as 63% of TCs failed to use or did not recognize combining codes 68x with ED 450 Healthcare Common Procedure Coding System 99291.
  
  
  CONCLUSIONS
  Significant underused opportunities exist for enhanced revenue by improved implementation of trauma response codes. Wide ranges in charges and the low frequency of full implementation suggest that education and coordination are needed among hospital departments involved, as well as among the trauma care community at large, to realize optimal reimbursement for trauma care services.
authors.affiliation: Department of Surgery, National Foundation for Trauma Care/Trauma Center Association of America, Las Cruces, New Mexico, USA. fakhry@musc.edu
authors.forename: Samir M
authors.initials: SM
authors.lastname: Fakhry
authors.forename: Connie
authors.initials: C
authors.lastname: Potter
authors.forename: Wallace
authors.initials: W
authors.lastname: Crain
authors.forename: Ronald
authors.initials: R
authors.lastname: Maier
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S.; D016009:Chi-Square Distribution; D005377:Financial Management, Hospital / Q000191:economics; D049228:Healthcare Common Procedure Coding System / Q000191:economics*; D017722:Hospital Charges; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D016014:Linear Models; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D011795:Surveys and Questionnaires; D014193:Trauma Centers / Q000191:economics*; D014481:United States