ED Coding and Reimbursement Alert

Question: A parent brings a 9-year-old child into the ED with blistering burns to the left side of her body. After a level-four E/M, the ED physician treats the child for partial-thickness burns on her entire left arm and left leg. The child suffered no third-degree burns. How should we code this scenario?

Tennessee Subscriber

Answer:  To better understand the coding of this encounter, we'll assign CPT® codes first and then delve into ICD-9 coding:

CPT® codes: Your ED physician provided a separate E/M, then treated the patient's burns, meaning you can report a pair of CPT® codes. On the claim, report the following:

• 99284 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: a detailed history; a detailed 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) linked to 99284 to show that the E/M and burn treatment were separate services
• 16030 (Dressings and/or debridement of partial-thickness burns, initial or subsequent; large (e.g., more than one extremity, or greater than 10% total body surface area) for the burn treatment.

ICD-9 codes: Be careful when assigning ICD-9 codes for this scenario. Be sure to include ICD-9 codes to represent each burn, and a 948.xx code to show the total body surface area (TBSA) of the child's burns. When choosing the 948.xx code, be sure to use the Pediatric "Rule of Nines" to calculate TBSA burned. CPT® and ICD-9-CM break down the Rule of Nines as follows for pediatric patients:

• The head accounts for 18 percent
• The chest and back each equal 18 percent
• Each arm accounts for nine percent
• Each leg equals 14 percent

So your patient had burns to 23 percent of her body in this instance (14% (left leg) + 9% (left arm) = 23%), and no third-degree burns. On the claim, you would link all of the following diagnosis codes to 99284 and 16030:

• 943.29 (Burn of upper limb, except wrist and hand; blisters epidermal loss [second degree] multiple sites of upper limb, except wrist and hand,) for the patient's arm burn
• 945.29 (Burn of lower limb[s] blisters epidermal loss [second degree]; multiple sites of lower limb) for the patient's leg burn
• 948.20 (Burns classified according to extent of body surface burned; 20-29% of body surface; less than 10 percent or unspecified) to represent TBSA burned.