ED Coding and Reimbursement Alert

Did doc deal with blisters? It could be a partial-thickness treatment.

Summer's the season of the burn.

Sunburn, charcoal burn, fireworks burns ... all can result in ED presentations..

Follow these three steps, and pay attention to how many layers of skins the burn penetrates, when coding your ED physician's burn treatment services.

Step 1: Verify Burn Treatment Occurred

There are certain situations in which the physician might treat a burn that does not qualify for 16000-16030 service, confirms Sharon Richardson, RN, coder in the Compliance Office of Emergency Groups' Office in Arcadia, Calif.

You'll include burn treatment in the ED E/M code "if the burn was minor enough that no real treatment was provided, such as dressing, debridement, or local treatment," explains Richardson. You'd most likely code an E/M for a very small non-blistered sunburn.

Example: A patient reports to the ED with a reddened left arm; he says he was driving to the beach with his arm out the open window, and it was "really red" when he finished the trip three hours later. A qualified nonphysician practitioner (NPP) examines the area, notes no blisters or broken skin, and diagnoses sunburn. She tells the patient to stay out of the sun and to take over-the-counter ibuprofen for the pain. Notes indicate a level-two service.

In this instance, the NPP examined the sunburn but did not provide any local treatment, above and beyond the evaluation and management service. On the claim, you'd report 99282 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making of low complexity ...) for the encounter.

Step 2: Look for These Key Terms for 16000 Success

If you're having trouble identifying burn treatment coding opportunities, look out for these indications in the documentation:

1. "If local treatment of a first-degree burn occurs, such as cleaning and ointment, then 16000) would be billed," Richardson says.

2. "A first-degree burn affects the epidermis only. Usually, there is no blistering," reminds Jaime Darling, CPC, coder at EA Health Corporation in Solana Beach, Calif.

Reality: The most likely treatment in 16000 (Initial treatment, first degree burn, when no more than local treatment is required) scenarios is topical medication application with substances such as Silvadene, triplebiotic ointment, etc.

"In my experience, bandages are possible but unlikely for most first-degree burns; they rarely require any treatment except application of moisturizer to soothe the skin. In some cases a topical anesthetic might be applied," confirms Darling.

Example: A patient reports to the ED with a burn on the bottom left side of his trunk and the top of his left thigh; he was jumping up to catch a football at a picnic, and ran into a hot grill as he landed. The physician examines the patient's wound and the surrounding area. The first layer of skin is burned away on in the left hip area, but there are no blisters, particulate matter, or signs of further injury. The NPP applies Silvadene and instructs the patient on how to care for the burn. Notes indicate a leveltwo E/M service accompanied the burn treatment.

In this scenario, report the following CPT codes:

• 16000 for the burn treatment
• 99282 for the E/M service
• 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 99282 to show that the E/M and burn treatment were separate services.

Step 3: Discover Debridement and Look to Partial-Thickness Codes

Though less frequent, your physician might also treat patients with partial-thickness burns, which you'd code with the following, depending on the specifics of the encounter:

• 16020 (Dressings and/or debridement of partial-thickness burns, initial or subsequent; small [less than 5 percent of total body surface area])
• 16025 (... medium [e.g., whole face or whole extremity, or 5% to 10% total body surface area])
• 16030 (... large [e.g., more than 1 extremity or greater than 10% total body surface area]).

Characteristics: "A partial-thickness burn would have blistering or loss of skin if the blister has broken and loss of the skin occurs; in this case the physician would most likely debride the remaining skin and apply a dressing," Richardson says.

When the physician performs partial-thickness burn repair, he might use Silvadene during the procedure, but would "most likely use some type of non-adherent dressing; I have seen Xeroform, Adaptic and other types of non-adherent dressings used," says Richardson.

If you see encounter notes that contain some of the above elements, examine the opportunity to choose 16020-16030. Keep in mind that you'll use these codes for dressings/debridement of partial thickness burns. Also, note that the codes are broken up based on the percentage of total body surface area (TBSA) burned.