Medicare Compliance & Reimbursement

The ICD-10-CM index entry for hay fever refers you to J30.1. Additionally, “hay fever” is listed as one of the synonyms for J30.1. And finally, “you would report J30.2 if airborne mold spores or dust mites cause the condition; whereas you would report J30.1 for hay fever as the code specifically cites pollen as the cause,” Witt adds.

Keep Sunburn Coding in the Pink — and Out of the Red Zone

Summer often brings an uptick in the number of sunburn cases you’ll see. Your coding may seem straightforward, but there are a few fine points to keep in mind.

Consider this example: A woman reports to your office after being sunburned following a day at the beach. The physician determines she has a first-degree sunburn of her upper legs, and second-degree sunburns on her shoulders and entire back.

First-degree burns only affect the surface of the skin and require little, if any, treatment. However, the provider may decide to provide some kind of service for this condition.

If this is the case, Donelle Holle, RN, President of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana, suggests using burn code 16000 (Initial treatment, first degree burn, when no more than local treatment is required) for the sunburn of the patient’s upper legs. “For the first-degree sunburn, there will be no other treatment other than local treatment,” Holle adds.

Typically, the procedure would involve the provider applying some form of topical medication, such as aloe vera lotion or an antibiotic ointment. There is usually no dressing required for minor burns such as this.

The second-degree burns to the shoulders and back are more severe, however, requiring more extensive treatment. Because they have gone below the surface of the skin and into the dermis, they are regarded as being partial-thickness burns. This means that they have probably blistered, so the burn area will probably require debridement and dressing.

This will lead you to choose a code from 16020-16030 (Dressings and/or debridement of partial-thickness burns, initial or subsequent ...). Holle notes that code choice here will depend on the provider’s documentation of the amount of surface area affected, as the codes are size dependent.

“If the burn is less than 5 percent of the total body surface area, which is likely the case, use the code 16020 [... small (less than 5% total body surface area)],” Holle advises.

Coding note: As second-degree burns are deep, they won’t heal as quickly, so there is a good chance that your patient may report back to your office for further debridement and a change of dressing. If this is the case, there will probably not be a need to code for an E/M service.

These types of burns usually require daily visits until the burn is in the healing stage. Consequently, these are planned procedures, and there is no need for further assessment other than the assessment related directly to the burn. So, don’t be afraid to code 16020 a second time. Per CPT^®, the code has zero global days.

Diagnosis coding: Depending on the degree of the case of sunburn you determine, you will report one of these ICD-10-CM codes for the sunburn diagnosis:

• L55.0 – Sunburn of first degree
• L55.1 – Sunburn of second degree
• L55.2 – Sunburn of third degree
• L55.9 – Sunburn, unspecified.

Take the Sting Out of Insect Bite Coding

For most patients, stings and bites generally cause itching and mild discomfort. But for others, a sting or bite can cause anaphylactic shock, which can range in severity from a rash or hives to a potentially life-threatening closure of the airways.

Bites from mosquitos and ticks can also produce rashes that are symptomatic of other dangerous conditions such as Rocky Mountain spotted fever and Lyme disease.

And the coding can be tricky, as “you need to keep in mind that there are over 350 diagnoses that could relate based on site and care,” says Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California. “The seventh digits, A [Initial encounter], D [Subsequent encounter], and S [Sequela], will also play a role in each case,” Johnson adds.

Diagnosis coding: For rashes caused by nonvenomous insect bites, you’ll first want to code the condition associated with the bite, such as A77.0 (Spotted fever due to Rickettsia rickettsii) for Rocky Mountain spotted fever and A69.2- (Lyme disease) for Lyme disease. Then you will use W57.XX (Bitten or stung by nonvenomous insect and other nonvenomous arthropods) for the bite, using the appropriate seventh character to document the encounter.

However, rashes caused by bee stings and other venomous animal or insect bites are coded differently. Again, you’ll code the condition first — in this case, anaphylactic shock using T78.2XX- (Anaphylactic shock, unspecified), adding the appropriate seventh character to document the encounter. Then you will use T63.4- (Toxic effect of venom of other arthropods), adding the appropriate fifth digit for the kind of insect, the appropriate sixth digit to indicate intentionality, and the appropriate seventh character again to document the encounter. And this time, you will add an encounter code from Z91.03- (Insect allergy status) to indicate the anaphylaxis.