ED Coding and Reimbursement Alert

Question: When my ED physicians treat a burn, can we also report an ED E/M service on the same claim?

New Mexico Subscriber

Answer: Lesser burns will likely only require an E/M service, but you can typically report both if the documentation shows evidence of separately identifiable burn treatment. If a burn does not require any treatment, then a code from the 16000 series may not be appropriate and you should typically report the service with an E/M code. For example a college student reports to the ED concerned about his painful sunburned back. The attending doctor examines the patient's injury, and decides that it is superficial and will heal on its own without any burn treatment. This scenario would result in a low-level E/M such as 99282 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity).

A second or third degree burn will usually require an E/M code along with treatment; however if even a sunburn, if serious enough, can qualify for separate burn code. If local treatment occurs, choose 16000 (Initial treatment, first degree burn, when no more than local treatment is required) for the encounter, which typically includes use of topical medication such as silvadene, and some pain relief. If chart documentation supports both the ED E/M and the burn code, you can report both, but don't forget the 25 modifier on the E/M to show it was separately identifiable.