ED Coding and Reimbursement Alert

Question: When coding for the professional side, when should I report burn codes? At our hospital, whenever someone comes into the ED with a burn the physician evaluates the injury and determines the required treatment, and if that includes debridement it's usually done by the physician.

Massachusetts Subscriber


Answer: If your physician performs burn care and debridement, then code the service provided. But if the doctor did not directly perform the treatment, keep in mind that Medicare does not recognize the "incident-to" provision in the ED and may not feel that the doctor was directly involved to the extent to support reporting a burn service code.
 
Since the burn codes come from the surgery section in CPT, a good procedure note supports that it is a separately identifiable service. Many private payers may have different rules since they do not pay the hospital directly through Medicare part A. If you opt not to report the burn care, include the treatment plan work in the E/M code.
 
You would then report the appropriate emergency department E/M code (99281-99285).
 
Because the risk is high with many burn victims, your E/M code will often end up as a level four (99284, Emergency department visit for the evaluation and management of a patient, which requires these three key components: a detailed history, a detailed examination, and medical decision-making of moderate complexity) or level five (99285, Emergency department visit for the evaluation and management of a patient, which requires these three key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: a comprehensive history, a comprehensive examination, and medical decision- making of high complexity).