Pediatric Coding Alert

Question: A pediatrician sees a child with first- and second-degree burns on her hand. The physician cleans and dresses the burn, but doesn't perform debridement. Should I bill 16000 and 16020?


Rhode Island Subscriber


Answer: No. You should only report 16020 (Dressings and/or debridement, initial or subsequent; without anesthesia, office or hospital, small). A burn usually involves more severe burning in the center - the second-degree burn - and radiates out with less severe burning on the outer edges - the first-degree burn. The more complicated treatment of the second- degree burn (16020) would include the adjacent simpler treatment of the first-degree burn (16000, Initial treatment, first-degree burn, when no more than local treatment is required).

But if you treat a patient for two separate burns, you should report both 16020 and 16000. In this case, you would use 16000 to describe the pediatrician cleansing, applying ointment and dressing the first-degree burn. For dressing and/or debriding the second-degree burn, you would report 16020.
 
You will also have to append modifier -59 (Distinct procedural service) to 16000. The modifier indicates the pediatrician treated the first-degree burn on a separate site from the dressing and/or debridement.

Without modifier -59, insurers may bundle 16000 into 16020. The National Correct Coding Initiative, version 11.0, indicates that 16000 is a component of 16020. The edit contains a "1" modifier. Therefore, you may use a modifier to override the bundle if circumstances - such as a separate anatomic site - justify unbundling the codes.