ED Coding and Reimbursement Alert

Question: A patient reports to the ED with first- and second-degree burns to his abdominal wall from a steam burn. During an ED E/M service, the nonphysician practitioner (NPP) uses gauze and topical ointment to treat the patient's burn. Notes indicate that the anterior trunk is "18% burned." How many diagnosis codes should I include on the claim?

Georgia Subscriber

Answer: You'll report two diagnosis codes; one for the burn and one for the total body surface area (TBSA) burned.

On your claim, report the following:

• The appropriate level ED E/M code (99281-99285, Emergency department visit for the evaluation and management of a patient, which requires these 3 key  components: ...) based on the notes
• 942.23 (Burn of trunk; blisters, epidermal loss [second degree]; abdominal wall) appended to the E/M code to represent the burn
• 948.10 (Burns classified according to extend of body surface involved; 10-19 percent of body surface; less than 10 percent or unspecified) appended to the E/M code to represent the total body surface area (TBSA) burned.

Why no 1st-degree? When the patient suffers from burns of varying degrees in the same area, you'll choose a diagnosis code that represents the highest-level burn in the area.