ED Coding and Reimbursement Alert

You may mistakenly believe you should report an E/M code (99281-99285) only for emergency department (ED) burn visits, but you are losing out on valuable reimbursement by forgetting about the 16000 series.

Suppose a patient comes into the ED with a first-degree burn from a kitchen fire. Code 99282 has a relative value unit (RVU) of 0.73, while code 16000 has an RVU of 2.02, more than twice the value paid for the E/M. The appropriate code from the burn series could raise your reimbursement substantially. You will usually see cases that warrant reporting both the E/M and burn code. Remember, though, that you should report burn treatment codes only when the physician personally provides the service, not when he or she only assesses and dresses the burn. For burn assessments without physician involvement in the dressing application, you would report only the appropriate E/M code.
 There are several common burn codes you will see in the ED:

 16000 Initial treatment, first-degree burn, when no more than local treatment is required

 16020* Dressings and/or debridement, initial or subsequent; without anesthesia, office or hospital, small

 16025* and 16030 without anesthesia, medium or large.

Follow the Rule of Nines

To report a burn code, you must determine whether the burn is small, medium or large. You should apply the Rule of Nines described for an adult and child in the CPT and ICD-9 manuals. Category 948.x (Burns classified according to extent of body surface involved) for diagnostic coding is based on the Rule of Nines to estimate the amount of body surface burned, says Katie Cianciolo, RHIA, CCS, CCS-P, a coding consultant.

This rule divides the body into 9 percent increments to make it easier for you to calculate the total body surface area affected by the burn, Cianciolo says:
   The 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 and each leg can be divided into upper and lower segments, each equaling 9 percent).
   The genitalia equal 1 percent.

Based on these rules, the physician can calculate the total percentage of the body that was burned, she says. Cianciolo gives an example of a patient who has 10 percent first-degree, 15 percent second-degree, and 30 percent third-degree burns of the trunk. This corresponds to the diagnosis code 948.53 (50-59 percent of body surface; 30-39 percent third degree).
Use 16000 Codes With ED Burns

Most ED visits will encompass both an E/M service and a burn treatment service. The 16000-16036 series is for local treatment of burned surfaces only, and the physician must still perform an assessment (E/M) that [...]