General Surgery Coding Alert

These 4 tips will help you get the payment you deserve

If you're relying on the 16000-16030 code range to report all burns, you're forfeiting pay for separately reimbursable procedures such as skin grafts and escharotomy not included in these codes. Our coding experts offer these four tips for improving your burn treatment reimbursement. 1. Rely on Surgeon to Determine 'Small,' 'Medium' or 'Large' Surgeons must often treat burns with a combination of techniques. If the surgeon debrides or curettes a burn only, you should select an initial treatment code from one of the following:

16000 - Initial treatment, first-degree burn, when no more than local treatment is required
16010 - Dressings and/or debridement, initial or subsequent; under anesthesia, small
16015 - ... under anesthesia, medium or large, or with major debridement
16020* - ... without anesthesia, office or hospital, small
16025* - ... without anesthesia, medium (e.g., whole face or whole extremity)
16030 - ... without anesthesia, large (e.g., more than one extremity). Select 16000 when the surgeon tends to a first-degree burn only (burns affecting only the epidermis), says Stephanie Collins, CPC, healthcare consultant with Gates, Moore & Company in Atlanta.
 
For more extensive burns, you must choose among codes 16010-16030. You do not determine the appropriate code by debridement depth, as is usually the case, Collins says. Instead, select codes depending on if the surgeon anesthetizes the patient, as well as the size of the affected area.
 
For example, Collins says, if the surgeon treats more than one extremity with the patient under anesthesia, you should use 16015; if the surgeon does not anesthetize the patient, you should report 16030. Similarly, for treatment of an entire extremity (or the face), use 16025 if the surgeon does not use anesthetic, or 16015 if the surgeon does sedate the patient. For small debridements under anesthesia, select 16010; if the patient did not received anesthesia, use 16020.
 
The surgeon must determine whether the affected area qualifies as small, medium or large, using the CPT descriptors as a guideline. The surgeon should clearly state the size of the affected area in his or her documentation to support any code selection. 2. Claim Skin Grafts, When Applicable Because codes 16000-16030 describe immediate local treatment of the burn surface only, you may report skin grafts separately if the surgeon performs them, Collins says. You should select the appropriate skin graft code(s) from the 15100-15650 portion of CTP.
 
For example, the surgeon treats a patient with third-degree burn on the left arm, using anesthesia. In addition, he uses a free, full-thickness graft measuring 40 square cm to close the wound. In this case, you should report 16010 for the initial burn treatment and 15220 (Full thickness graft, free, [...]