General Surgery Coding Alert

Modifier 59 remains a possibility, but you need to know when to use it

The most recent version of the Correct Coding Initiative (CCI) has some edits you won't want to miss if your surgeon performs debridement and treatment on the same burn site.

CCI version 13.1 outlaws reporting a pair of debridement codes with certain burn treatment codes in most situations.

Specifically, CCI now bundles 11000 (Debridement of extensive eczematous or infected skin; up to 10 percent of body surface) and 11040 (Debridement; skin, partial thickness) into 16020 (Dressings and/or debridement of partial thickness burns, initial or subsequent; small [less than 5 percent total body surface area]), 16025 (... medium [e.g., whole face or whole extremity, or 5 percent to 10 percent total body surface area]) and 16030 (... large [e.g., more than one extremity, or greater than 10 percent total body surface area]).

-Most of these edits seem to be trying to reduce redundant coding,- says Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.

Explanation: -The burn code descriptions include debridement, so you should not report both codes- when treatment occurs on the same wound, Moore says.

For example, a patient reports to the emergency department for treatment of a small partial-thickness burn on his arm. During the encounter, the physician performs debridement on the burn before treating it. In this instance, the debridement is bundled into the burn treatment. You should report 16020 for this encounter.

Look for Exceptions

All of these burn/debridement edits contain a modifier indicator of -1.- The -1- means you can report both of these codes for the same encounter in certain situations--and with modifier 59 (Distinct procedural service) attached to the component (bundled) code.

Consider this scenario, in which you could rightfully unbundle these edits and report a debridement and burn treatment code:

A 25-year-old male reports to the office four days after suffering grease burns while working as a cook. The left arm has a small second-degree burn, which the surgeon debrides and then treats with topical silvadene. The right arm has several large areas of infected necrotic skin from old injuries, likely resulting from several untreated lacerations. The surgeon debrides the infected skin on the right arm and places the patient on oral antibiotics.

In this scenario, you can report the debridement and the burn treatment because the procedures occurred on different body areas, says Michael Granovsky, MD, CPC, FACEP, vice president of MRSI, an ED coding and billing company in Woburn, Mass.

On the claim, you would report:

- 16020 for the left arm burn treatment.

- 11000 for the debridement of the infected skin on the right arm.

- modifier 59 attached to 11000 to show that the burn treatment and debridement were separate.

In addition, be sure to attach a correct diagnosis code to the debridement to support the need for the separate service. You should link the burn diagnoses only to 16020 in this case. You should link a skin ulcer or open wound code (as appropriate) to 11000 to clarify why the surgeon performed the separate debridement.