Pediatric Coding Alert

Question: Our physician treated a four-year-old patient with a bad sunburn. We were going to report an E/M code but one of our doctors remembered reading that they could report burn treatment instead. Is this true?

Answer: The answer depends on what type of burn the patient had and what sort of treatment the pediatrician provided. Just because a patient’s parent diagnoses a child as “burned” after being in the sun too long doesn’t mean you automatically choose a burn treatment code for the encounter. In fact, the majority of pediatric sunburn cases merit E/M codes.

Example: An established patient visits the office because he burned his face while floating in the pool while on vacation. The pediatrician examines the patient’s face and decides the burn is superficial and will heal on its own in a few days. The pediatrician advises the patient to avoid touching his face and to avoid the sun for the next two weeks. She recommends using a topical aloe gel to help relieve pain. Since the physician didn’t spend a lengthy amount of time examining or counseling the patient, and didn’t administer any treatment, the visit leads to a low-level E/M code such as 99212 (Office or other outpatient visit for the evaluation and management of an established patient ...).

If, however, the pediatrician provides local treatment to the first-degree burn, choose 16000 (Initial treatment, first degree burn, when no more than local treatment is required) for the encounter. A first-degree burn usually only reddens the skin. The patient might have some swelling and mild blistering, but this is normal and usually resolves quickly. Treatment of a burn categorized by 16000 would typically include use of topical medication, such as a topical anesthetic. The physician might also apply bandages to the burned area, but first-degree burns rarely require more than an application of moisturizer to soothe the skin. These codes also typically require some type of debridement and dressing of the burn area.