Trauma team activation

Applies to:

All plans

Medicare plans follow Medicare coverage and billing rules

Definition

Trauma team activation is a response by key hospital personnel to triage information provided by pre-hospital caregivers in advance of a patient's arrival.

Trauma team activation billing

Payable:

When billed with trauma response revenue codes 0681, 0682, 0683 or 0684

When billing meets the UB-04 guidelines, below

When supporting documentation is submitted with the claim

Not payable:

When no advance notice was received

When documentation supporting the claim is missing

UB-04 billing guidelines

Priority Health has adopted the following UB-04 guidelines:

• The pre-hospital notification must meet local, state, or the American College of Surgeons field triage criteria, or be delivered via inter-hospital transfer.
• The notification must be given the appropriate team response.
• Revenue codes 0681-0684 are used for reporting the trauma activation costs only. They do not replace or substitute for the emergency room visit fee.

Patients who arrive without advance notice

Without advance notice, do not bill trauma team activation. Patients may be classified as trauma using type of admission code 05.

Required supporting documentation

If documentation is not submitted for review with the claim, the claim line will be denied.

It must clearly note:

• That the trauma facility was notified prior to the member's arrival
• Which providers were notified, at what times
• That the notice prompted the activation of the trauma team