Revenue Cycle Insider

Only use code 16000 if treatment was performed.

With summer fast approaching, children will be outside and exposed to sunshine, which means sunburn cases will be on the rise in your pediatric practice. Coding for sunburns may appear simple, but don’t be fooled into thinking coding this condition is a breeze.

Examine the information below along with a coding example to safeguard you from getting burned by denials while coding sunburn cases this summer.

Look to These Burn CPT^® Selections

Below are the most-used codes for first- and second-degree burns:

• 16000 (Initial treatment, first degree burn, when no more than local treatment is required)
• 16020 (Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area))
• 16025 (… medium (eg, whole face or whole extremity, or 5% to 10% total body surface area))
• 16030 (… large (eg, more than 1 extremity, or greater than 10% total body surface area))

If your provider treats a first-degree burn using treatment such as cleansing and ointment, then 16000 is appropriate. A first-degree burn affects the epidermis only.

The most likely treatments reported with 16000 involve the use of cool compresses, and topical medication application such as Silvadene or triple biotic ointment. These burns rarely require dressings, but some physicians may apply topical anesthetics to relieve pain.

Make note: Not every burn patient will require treatment that qualifies for a code from the 16000-16030 series. If the burn was minor enough that no treatment was provided, such as a minor sunburn that required no dressing, debridement, or local treatment, you should include the burn treatment in the evaluation and management (E/M) code for your service that day.

Choose the Correct ICD-10-CM Code

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): This level of burn affects the surface of the skin and requires little, if any, treatment. However, the provider may decide to provide some kind of service for this condition such as applying aloe or an antibiotic ointment to aid in healing. There is normally no dressing applied to minor burns like this.
• L55.1 (Sunburn of second degree): A second-degree sunburn is more severe, however, and requires more extensive treatment. Because the burn has penetrated below the surface of the skin and into the dermis, these are regarded as partial-thickness burns. This means that the patient most likely has blisters, so the burn area will normally require debridement and dressing.
• L55.2 (Sunburn of third degree): This level of sunburn is characterized by intense red to purple skin discoloration and the formation of blisters. The patient may also be experiencing symptoms such as chills, a slight fever, nausea, headaches, or signs of dehydration.
• L55.9 (Sunburn, unspecified): Use this code when you don’t have definitive details about the severity of the sunburn.

Try Coding This Example

A 7-year-old established patient is brought in by their parent after being sunburned following a day spent at a water park. The physician determines the patient has a first-degree sunburn on their upper legs and second-degree sunburn on their shoulders and back, which have now blistered. The practitioner applies antibiotic cream to the patient’s thighs. They debride, clean, and dress their back and shoulders.

In this case, you should begin by using code 16000 for the treatment of the sunburn of the patient’s upper legs. Usually, the provider applies a topical treatment like aloe vera lotion or an antibiotic cream in this situation, but no dressing needs to be applied to the legs in this scenario.

Because the burns on the patient’s back and shoulder are second-degree burns and more severe, they will require more extensive treatment. These have gone into the dermis and are regarded as being partial-thickness burns as they have blistered. Your coding choice here will depend on the total body area affected. Code 16020 is most appropriate since less than 5 percent of the patient’s total body area is affected.

On your claim, you should report:

• 16000 for the application of ointment to the burns on the patient’s legs
• Modifier 59 (Distinct procedural service) added to 16000 to keep it from bundling to 16020
• 16020 for the cleaning, debridement, and dressing of the blisters on the patient’s shoulders and back
• L55.0 appended to 16000 to represent the patient’s first-degree sunburn of the legs
• L55.1 appended to 16020 to represent the patient’s second-degree sunburn of the shoulders and back
• X32.XXXA (Exposure to sunlight) appended to 16000 and 16020 to add more details for the payer
• Y92.34 (Swimming pool (public)) appended to 16000 and 16020 to clarify to the payer that the injury occurred at a water park

Coding tip: If you are nervous about coding the total body area affected, and the practitioner’s notes are unclear, it is best to query them before choosing your code.

As second-degree burns are deep, and won’t heal as quickly, there is a good chance that the patient may report back to your office for further debridement and a change of dressing.

Because any follow-up care will be considered a planned procedure, there is no need for further assessment other than that related directly to the burn, so no E/M coding will be necessary. Therefore, don’t hesitate to use the 16020 code each time the patient visits your office for the same burn. Per CPT^®, the code 16020 has zero global days

Lindsey Bush, BA, MA, CPC, Production Editor, AAPC