General Surgery Coding Alert

Reserve 20000 incisions for fascia covering muscle.

The procedure is similar -- your surgeon incises tissue to relieve swelling -- but the codes are different.

When your surgeon performs escharotomy for patients with third-degree burns, make sure you don't choose a fasciotomy code for the procedure. If a coder keys in on body site where the surgeon performs the incision, coming up with the wrong code would be easy.

Stick to Skin

The CPT musculoskeletal system includes codes for "fasciotomy" or "decompression fasciotomy" under the "incision" subheading for many body sites, such as the following codes:

• 25020- 25023 -- Decompression fasciotomy, forearm and/or wrist, flexor OR extensor compartment; ...
• 26121 -- Fasciotomy, palm only, with or without Zplasty, other local tissue rearrangement, or skin grafting (includes obtaining grafts)
• 27025 -- Fasciotomy, hip or thigh, any type.

"Fasciotomies involve incising the fascia covering a muscle, usually after some type of blunt trauma has caused swelling of that muscle," explains Marcella Bucknam, CPC, CCSP, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program in Seattle.

In contrast, the escharotomy codes involve the surgeon incising the full thickness of skin (dermis and epidermis down to the fascia) damaged in a third-degree burn injury. Adding to the confusion is the fact that surgeons sometimes use the term "fasciotomy" to refer to deep skin incision for third-degree burn treatment.

Better: Select the escharotomy codes when the surgeon performs an incision over an area of third-degree burns:

• 16035 -- Escharotomy; initial incision
• +16036 -- ... each additional incision (List separately in addition to code for primary procedure).