Pediatric Coding Alert

Question: A mother brought her child to our office with swelling and minor blisters on the tops of his feet. The pediatrician diagnosed sunburn and treated it with a cold, wet compress on the area. He discussed several factors with the mother (the sunburn, expected progression, proper treatment, pain management, prevention). Should I use an E/M code for the burn treatment?

Colorado Subscriber

Answer: Because the burn care involved treatment, you can report 16000 (Initial treatment, first degree burn, when no more than local treatment is required) for the service. You can also report an E/ M code if the physician's documentation supports a significant, separately identifiable service. Choose the appropriate E/M code, such as 99212 (Office or other outpatient visit for the evaluation and management of an established patient ...). Append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99212 (or other appropriate E/M service), and you should expect full pay for both the E/M service and sunburn care.

Answers for You Be the Coder and Reader Questions were reviewed by Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville.