ED Coding and Reimbursement Alert

Question: A patient reports to the ED with a partial-thickness burn on his face. Encounter notes indicate that the physician debrided the burn, then treated it. Should I report codes for the debridement and the burn treatment?


Oregon Subscriber

Answer: No, you should not report the debridement in this instance. The debridement is bundled into the burn treatment code, according to the Correct Coding
Initiative (CCI).

On the claim, report 16025 (Dressings and/or debridement of partial-thickness burns, initial or subsequent; medium [e.g., whole face or whole extremity, or 5 percent to 10 percent total body surface area]) for the burn treatment.

Do not report 11040 (Debridement; skin, partial thickness) on this claim. The descriptor for 16025 includes debridement, so you can't report both codes when the physician performs both procedures on the same wound during the same session.

According to CCI, the two debridement codes (11000, Debridement of extensive eczematous or infected skin; up to 10 percent of body surface, and 11040) are bundled into the following treatment codes:

- 16020 (- small [less than 5 percent total body surface area])
- 16025
- 16030 (- large [e.g., more than one extremity, or greater than 10 percent total body surface area]).

Rare exception: Each of the above bundles has a modifier of -1,- meaning it is possible to report both of these codes for the same encounter in certain situations--and with modifier 59 (Distinct procedural service) attached to the component (bundled) code.

For instance, if the ED physician performs burn treatment on one anatomic area, then debrides skin in another anatomic area, you might unbundle the codes.