Anesthesia Coding Alert

Anatomic site is paramount to your selection.

Coding for burn care can get tricky from an anesthesia perspective, because you don't simply crosswalk from a surgical code and add time units. Instead, you have to get specific details about the case and practice your math skills so you won't get burned by too little reimbursement.

Step 1: Know the Codes to Use – and Not Use

As an anesthesia coder, you're accustomed to focusing on anatomic site when filing claims. For burns, however, you focus on the extent of the injury and how much body area is involved (known as the total body surface area, or TBSA).

You'll find three codes in CPT^® 2017's anesthesia section for burn excision and debridement. They are:

• 01951 – Anesthesia for second- and third-degree burn excision or debridement with or without skin grafting, any site, for total body surface area (TBSA) treated during anesthesia and surgery; less than 4% total body surface area between 4 percent and 9 percent of total body surface area
• 01952 – ... between 4% and 9% of total body surface area
• +01953 – ... each additional 9% total body surface area or part thereof (List separately in addition to code for primary procedure).

Take note: Because +01953 is an add-on code, remember that payers will only reimburse you when you submit it with the appropriate primary code: 01952. And, because of its add-on status, code +01953 is worth one additional base unit, but you do not report time for it.

Pay attention: Verify whether the payer in question reimburses for physical status modifiers (P1-P6, listed in the introduction to CPT^®'s anesthesia section). If so, remember to include the appropriate one if the insurance will cover it, advises Kelly D. Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla.

Step 2: Get Ready for Math Fun

As you can see by the descriptors for 01951-+01953, each code is based on the amount of body surface area affected by the burns.

The surgeon is the best judge of TBSA, but he might collaborate with your anesthesiologist to determine a final amount for each area. The areas should be clearly documented in both providers' records so their claims will be consistent.

For example, the anesthesiologist shouldn't bill for an 18 percent body burn when the surgeon claims a 32 percent body burn.

When it's time to choose the appropriate anesthesia code, you first calculate the percentage of involved skin by following the "Rule of Nines," says Pamela Biffle, CPC, CPC-P, CPC-I, CCS-P, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Austin, Texas. CPT^® and ICD-10 both include information on The Rule of Nines. The CPT^® illustration appears with burn treatment codes 16000-16030.

The Rule of Nines divides the body into certain areas to help you code burns by percentages. The calculations for children are a bit different, but the rule for calculating burns on adults states:

• head and neck, the right arm, and the left arm each equal 9 percent
• the back trunk, front trunk, left leg, and right leg each equal 18 percent (the front and back trunk are divided into upper and lower segments, and each leg is divided into back and front segments, each equaling 9 percent)
• genitalia equals 1 percent.
• Select the treatment code based on that percentage. However, you must also know how to convert any documented areas into percentages.

Example: A patient has third degree burns to 65 percent of his total body area. The operative report states that the surgeon debrided 1400 square cm of the chest and shoulders, but gives no other details. How do you calculate the correct percentage of burns to code?

Answer: Although 65 percent of the patient's body is burned, the surgeon is currently treating the chest and shoulders. The treated area represents upper chest (approximately 9 percent) and shoulders (approximately 3 percent each), for an approximate total of 15 percent. The applicable anesthesia codes are based on the total body surface area (TBSA) treated: for this case, 01952 and +01953. Submit 01952 once for the first 9 percent, then 01953 x 7 for the remaining 56 percent.

Pay attention: The code descriptor reads "or any part thereof." Reporting one unit of 01952 and 6 units of +01953 only adds up to 63 percent. Reporting 7 units of 01953 covers the entire area.

Step 3: Ask the Surgeon for More Information, if Needed

If the surgeon only documents the area being debrided – and not percentages affected – you can use the TBSA graphic in CPT^® or other sources to potentially determine the TBSA. Don't shy away from contacting the surgeon's office, however, if you aren't certain that method gives you an accurate enough percentage.

Also, don't guess or simply assign the lowest level of burn code if the physician doesn't document the TBSA, experts warn. Request additional information and communicate with the anesthesia provider to ensure he or she provides what you need.