ED Coding and Reimbursement Alert

Do you know when burn Tx isn’t reported with a burn Tx code?

When a patient reports to the ED needing burn treatment, everything isn’t cut-and-dried for the coder.

Why? There are different rules for different types of burns. Further, there could be additional services that you might be able to code for — or you might not be reporting a burn code at all, even if the ED physician treats a patient’s burns.

Confused? Don’t be. Check out this primer on coding burn treatment.

Start Burn Treatment With E/M

As with most ED patients, a burn patient’s journey through the ED will start with an evaluation and management (E/M) service, which you’d report with a code from 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), depending on encounter specifics.

This ED E/M could be the extent of the burn treatment; or it could be the precursor to a more involved procedure.

There are circumstances where a patient’s burn treatment would be so minor that it would be included in the overall E/M level, confirms Linda Martien, COC, CPC, CPMA, CRC, of Medical Revenue Cycle Management Consulting. A sunburn or a non-blistering oven burn, for example, would likely constitute an E/M service.

When the burn care starts and stops with the ED E/M, make sure you roll all of the work together when making your decision on which code to report from 99281-99285.

If, however, the burn requires more extensive treatment than an ED E/M, you can still report the ED E/M. Just be sure to choose your E/M level based on the services your physician provides outside of burn treatment, and 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 you choose.

Do This on 1st Degree Burns

You need to recognize when the treatment goes beyond an E/M service, however, so you can report a burn treatment code. If the ED physician treats a patient with a first-degree burn, you’ll report the service with 16000 (Initial treatment, first degree burn, when no more than local treatment is required).

Indications that the ED physician treated a first-degree burn patient include “terms like ‘superficial, reddened, erythematous’ in the documentation,” says Martien. Treatment methods for first-degree burns “might include the use of topical anesthetic, antibiotic ointments, or gels.”

Do This on 2nd Degree Burns

If the ED physician treats a patient with second-degree burns, coding changes. In these instances, you’ll report one of the following 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))

More info: “When using the term ‘partial thickness,’ providers usually are referring to the top layers of skin only,” explains Martien.

Second-degree burns will likely be the extent of your ED physician’s burn treatment services. Any patient with more serious burns will almost certainly be sent to the operating room (OR) for treatment.

Clinical Example Shows Burn Coding in Action

Consider this example from Martien:

A patient comes to the ED complaining of pain and burning in their right forearm. They state that they hit the roof of the oven with their right forearm, from wrist to midway up the forearm. This happened about half an hour ago.

The right forearm, on the superior aspect from wrist to mid-forearm, is reddened, blistered, and very painful. This constitutes second-degree burns comprising 3 percent total body surface area (TBSA).

The patient has sustained second-degree burns on her right forearm. The burned area was cleansed and then treated with Silvadene cream and lightly dressed with a non-adherent dressing and covered loosely with kerlix. The patient will see their primary care physician in seven to 10 days for recheck, or sooner if complications occur.

On the claim, you would report:

• 16020 for the burn treatment
• Modifier RT (Right side) appended to 16020 to indicate laterality
• An ED E/M code from 99281 through 99285 for the pre-procedure ED E/M
• 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) appended to the ED E/M code to show that the E/M and the burn treatment were significant, separately identifiable services.
• T22.211A (Burn of second degree of right forearm, initial encounter) appended to 16020 and the ED E/M to represent the patient’s burn.
• X15.0XXA (Contact with hot stove (kitchen), initial encounter) appended to 16020 and the ED E/M to represent the cause of the patient’s injury
• Y92.010 (Kitchen of single-family (private) house as the place of occurrence of the external cause) appended to 16020 and the ED E/M to represent the physical location where the injury occurred.