General Surgery Coding Alert

Question: In the emergency department (ED), our surgeon saw a 9-year-old girl 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 had no third-degree burns. How should we code this scenario? Tennessee Subscriber Answer: Because your surgeon provided a separate E/M and then treated the patient's burns, you can report a pair of CPT codes: - 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. - 99284 (Emergency department visit for the E/M of a patient, which requires these three key components: a detailed history; a detailed examination; and medical decision-making of moderate complexity) for the E/M service, appended with modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to show that the E/M and burn treatment were separate services. You must be careful when assigning ICD-9 codes for this scenario. Be sure to include codes to represent each burn, as well as a 948.xx code to show the total body surface area (TBSA) of the child's burns. When choosing the 948.xx code, use the pediatric "Rule of Nines" to calculate TBSA burned: - The head accounts for 18 percent
- The chest and back each equal 18 percent
- Each arm accounts for 9 percent
- Each leg equals 14 percent. Therefore, your patient had burns to 23 percent of her body (14 percent [left leg] + 9 percent [left arm] = 23 percent). There were no third-degree burns. On the claim, you would link all of the following diagnoses 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 arm - 945.29 (Burn of lower limb[s]; blisters, epidermal loss [second degree]; multiple sites of lower limb[s]) for the leg - 948.20 (Burns classified according to extent of body surface involved; 20-29% of body surface; less than 10 percent or unspecified) to represent the TBSA burned.