Pediatric Coding Alert

You won't feel the burn if you follow our experts' advice.

Summer is almost here, and your patients will be spending a lot of time having fun outdoors. That means your office will probably be seeing more than your usual number of patients with sunburn.

So, this is a good time to refresh your coding skills by coding this typical seasonal encounter.

Scenario: A 12-year old girl reports to your office after being sunburned following a day at the beach. Your pediatrician determines she has a first-degree sunburn of her upper legs, and second-degree sunburns of her shoulders and entire back.

Different Degrees, Different Procedures

First-degree burns: These kinds of burns only affect the surface of the skin and require little, if any, treatment. However, your pediatrician 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," Holle cautions coders, "there will be no other treatment other than local treatment."

Typically, the procedure would involve your pediatrician 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.

Second-degree burns: The 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 your 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" Holle reminds coders, "use the code 16020 [... small (less than 5% total body surface area)]."

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 evaluation and management (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.

Different Causes Result in Different Diagnoses

To code the patient's sunburn, Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico, tells coders to go to L55.0 (Sunburn of first degree) and L55.1 (Sunburn of second degree) to code the burns. Unlike the burn and corrosion codes (T20-T32), these codes are not site-specific, but you are required to specify the severity of the burn.

Coding alert: Even though the L55 codes are Excludes2 codes for T21.- (Burn and corrosion of trunk) and T22.- (Burn and corrosion of shoulder and upper limb, except wrist and hand), this does not mean that you can code them together. ICD-10 guideline 19.d. is very specific about this. In part, the guideline reads "The ICD-10-CM makes a distinction between burns and corrosions. The burn codes are for thermal burns, except sunburns, that come from a heat source, such as a fire or hot appliance."

Additionally, you might feel that it is appropriate to report Y92.832 (Beach as the place of occurrence of the external cause) to provide the location of the incident. Even though you are not required to do so, Witt suggests that "for complete information you can add Y codes that represent the activity involved and location where the sunburn occurred."

However, ICD-10 guidelines come into play in this situation, steering you away from reporting Y92.832. Guideline 20.b. states that a location code is a secondary code "for use after other external cause codes." In other words, as Witt sees it, "you have to use an activity code with a location code. As you only know where the child got the sunburn, but not how she got it," Witt argues, you would not record the location of the sunburn in this scenario.