ED Coding and Reimbursement Alert

Question: A patient came in with first- and second-degree burns on her hand. The physician cleaned and dressed the burn but didn't perform debridement. Should I bill 16000 and 16020? Rhode Island Subscriber Answer: You should report only 16020 (Dressings and/or debridement of partial-thickness burns, initial or subsequent; small [less than 5% total body surface area]) in this case. A burn usually involves more severe tissue damage in the center (the second-degree burn) and radiates out with less severe burning on the outer edges (the first-degree burn). The more complicated treatment of the second-degree burn (16020) would include the adjacent simpler treatment of the first-degree burn (16000, Initial treatment, first-degree burn, when no more than local treatment is required). Exception: But if your physician treats a patient for two separate burns, you should report 16020 for the second-degree burn treatment and 16000 for the first-degree burn treatment. You should also append modifier 59 (Distinct procedural service) to 16000. The modifier indicates that the doctor treated the first-degree burn on a separate site from the dressing and/or debridement. Without modifier 59, insurers may bundle 16000 into 16020.