ED Coding and Reimbursement Alert

Question: A father brings his 6-year-old son into the ED after the boy suffered a bicycle accident: he fell off his bike, and sustained pavement burns on his right forearm. During an expanded focused history and examination, the physician performs several cognitive tests to ensure the patient did not suffer any neurological damage. The physician also orders a forearm Xray, which reveals no fracture. The physician then uses pickup forceps, a scalpel and tweezers to remove several pieces of small gravel from the wound and debrides devitalized skin; notes indicate that the debridement was "mostly dermal." The physician then discharges the boy with a prescription for pain medication and instructions to follow up with his pediatrician in two weeks. Notes indicate moderate medical decision making during the encounter. Is this a simple or complex debridement?

Montana Subscriber

Answer: In your scenario, the physician provided simple debridement service. On the claim, report the following:

• 11040 (Debridement; skin, partial thickness) for the debridement
• 99283 (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 moderate complexity...) for the E/M
• Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99284 to show that the E/M and the debridement were separate services
• 881.00 (Open wound of elbow, forearm, and wrist: without mention of complication; forearm) appended to 10120 and 99283 to represent the patient's injury
• E826.1 (Pedal cycle accident; pedal cyclist) appended to 10120 and 99283 to represent the cause of the patient's injury.