ED Coding and Reimbursement Alert

Know when to report a procedure code for burn care.

In the last issue, we ran down the most vital information you’ll need to diagnose patients suffering from burns. This month, we look to round out that coverage with a look at the treatments your ED physician might provide to burn patients.

In her HEALTHCON 2024 session “Coding and Classifying Burns and Burn Care,” Nancy Reading, RN, BS, CPC, CPC-P, CPC-I, ran down the who, when, what, and why of reporting burn treatments in the ED.

For a more complete burn coding guidance package, pair this advice with “Follow These Steps to Burn Coding Success” in the May 2024 issue of ED Coding and Reimbursement Alert (Volume 27, Number 5).

Know Burn Levels

Though the ED physician won’t likely treat all types of burns, the coder should know all the burn levels—particularly since some of the terminology around them has changed, Reading said.

“The traditional classification of first-, second-, third-, or fourth-degree was replaced by a system reflecting the need for surgical intervention,” she explained. Current designations of burn depth are:

• Superficial,
• Superficial partial-thickness,
• Deep partial-thickness, and
• Full-thickness.

Note: In the ED, your physician is likely only going to handle superficial and partial-thickness burns. Treatment for full-thickness burns will necessitate surgery the ED doesn’t typically perform.

Look to 1600 for Superficial Burns

If a patient suffers a superficial burn, it involves only the epidermal layer of

the skin. “They do not blister but are painful, dry, red, and blanche with pressure,” relayed Reading. “Such injuries are generally healed in six days without scarring. This process is commonly seen with sunburns.”

There are some instances where these burns are so minor that you would not code them separately from the ED evaluation and management (E/M) service. If, however, the ED physician performs first-degree burn treatment, then you’ll report 16000 (Initial treatment, first degree burn, when no more than local treatment is required). This treatment generally involves the physician washing the burn with cold water that may or may not contain a disinfectant solution. They might then apply lotion or ointment locally and wrap the area in gauze.

When the ED physician performs 16000 treatment, they will also perform a separate E/M service, which you’d report with a code from the 99281 (Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional) through 99285 (Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making) code set.

Remember: Append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the ED E/M code to show that the E/M and burn treatment were separate, significantly identifiable services.

Use This Code Trio for Partial-Thickness Burns

The ED physician might also provide treatment for a patient with partial-thickness burns. According to Reading, “partial-thickness burns involve the epidermis and portions of the dermis. They are characterized as either superficial or deep.” With superficial partial-thickness burns, blisters will form within 24 hours between the epidermis and dermis. Superficial partial-thickness burns are red, painful, weeping, and blanche with pressure.

Deep partial-thickness burns extend into the deeper dermis and could damage hair follicles and glandular tissue, Reading said. They almost always blister, are painful to pressure only, and do not blanche with pressure. “Deep partial-thickness burns appear wet or waxy dry, and have variable mottled colorization from patchy, cheesy white to red,” she explained.

When the ED physician decides to perform partial-thickness burn treatment, you’ll head to these codes:

• 16020 (Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area))
• 16025 (… medium (eg, whole face or whole extremity, or 5% to 10% total body surface area))
• 16030 (… large (eg, more than 1 extremity, or greater than 10% total body surface area))

Remember Rule of Nines, Lund Browder Chart for TBSA