ED Coding and Reimbursement Alert

Question: A patient reports to the ED with extensive burns to her entire right arm. Notes indicate that the burns damaged both the dermis and epidermis, and the injured area featured blistering in the upper arm and moist red splotches in the lower arm. The physician debrides the loose skin on the arm, applies silvadene, and wraps the arm in gauze. Should I report 16000?

Nebraska Subscriber

Answer: The 16000 (Initial treatment, first degree burn, when no more than local treatment is required) code is for first-degree burns, but the injuries you describe seem more in line with a second-degree burn.

To most accurately report this encounter, choose the higher-paying 16025 (Dressings and/or debridement of partial-thickness burns, initial or subsequent; medium [e.g., whole face or whole extremity, or 5% to 10% total body surface area]).

Remember Rule of Nines: You-ll notice that the second-degree burn treatment codes represent a certain amount of total body surface area (TBSA) burned. For CPT coding, the Rule of Nines breaks the body into these percentages:

- head and neck: 9 percent TBSA

- each total arm: 9 percent

- chest: 18 percent

- back: 18 percent

- genitalia: 1 percent.

Since the treatment involved only one arm, the physician treated 9 percent TBSA.