ED Coding and Reimbursement Alert

ED coders must rely on specific physician documentation of medical history, physical examination of the burn and level of medical decision-making to assign the appropriate evaluation and management (E/M) code (99281-99285). Then, they must use the documentation of the physical examination and treatment to choose a burn treatment code (16000-16035, burns, local treatment) if applicable. Patients with larger second- and third-degree burns are more likely to require a higher level of care and additional procedures, which can increase the level of E/M code or even require critical care.

If a burn is associated with a potential for respiratory injury, the physician will evaluate the respiratory and cardiovascular systems (in addition to the actual burn injury), explains John Stimler, DO, FACEP, a practicing emergency physician in Jacksonville, Fla., and past president of the Florida chapter of the American College of Emergency Physicians. Inhalation injuries will lead to the patients admission, and the visit would usually be coded at the 99285 (emergency department visit for the evaluation and management of a patient, which requires these three key components within the constraints imposed by the urgency of the patients clinical condition and/or mental status: a comprehensive history; a comprehensive examination; and medical decision-making of high complexity) level. If the patient requires intubation or is being observed very carefully for impending respiratory failure, the critical care codes (99291-99292) may be used, provided the physician attended to the patient exclusively for 30 minutes or more.

BSA and Location May Matter More Than Degree of Burn

Treatment of small, localized burns, even if they are second- or third-degree, may be handled on an outpatient basis and not require a significant level of service.

A localized burnif not in areas such as the face, the perineum, etc.can often be managed as an outpatient, says Dennis Beck, MD, an emergency physician with Beacon Medical Services in Aurora, Colo. When dealing with localized burns, the physician is mainly determining at the outset whether the patient can be managed as an outpatient or needs to be admitted. Most departments have specific thresholds for the amount of body surface area (BSA) burned that requires the patients admission. Anything below that you could probably treat as an outpatient, Beck adds.

Emergency physicians usually will provide local treatment (i.e., debridement, dressing, ointment) for localized first-degree and second-degree burns, says Stimler. Typically, burn treatment procedures performed in the ED are reported with codes 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 (without anesthesia, medium [e.g., whole face or whole extremity]) or 16030 (without anesthesia, large [e.g., more than one extremity]), depending on the [...]