Practice Management Alert

Question: This summer, our practice has seen an overflow of sunburn patients. When patients report for sunburn treatment, how do you code for the service? And what is the proper ICD-10 code for patients with sunburns?

Massachusetts Subscriber

Answer: Sunburn treatment is typically an evaluation and management (E/M) service, which you would code with:

• 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making…) through 99205 (… a comprehensive history; a comprehensive examination; medical decision making of high complexity…) for new patients; and
• 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services) through 99215 (… a comprehensive history; a comprehensive examination; medical decision making of high complexity…) for established patients.

For example, an established patient visits the office because he’s concerned about his sunburned back.

The physician examines the patient’s back and decides the burn is superficial and will heal on its own in a few days. The physician advises the patient to avoid lying on his back and to wear his shirt while in the sun. She recommends using a topical aloe gel to help relieve pain.

E/M coding: The physician didn’t spend a lengthy amount of time examining or counseling the patient, and didn’t administer any treatment. Therefore, the visit leads to a low-level E/M code. There is no automatic E/M level for sunburn treatment, however. As always, make sure you choose the E/M code based on the provider’s actions, which should be reflected in the encounter notes.

Procedure possibility: Caring for sunburn injuries can result in a CPT^® procedure code instead of E/M. The seriousness of the burn and evidence of documented treatment will be your clues to consider different codes. If the physician provides local treatment to the patient’s sunburn, choose 16000 (Initial treatment, first degree burn, when no more than local treatment is required) for the encounter.

Head’s up: 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 probably 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.

ICD-10 alert: Depending on the degree of the sunburn, you will report one of these ICD-10 codes for the sunburn diagnosis:

• L55.0 — Sunburn of first degree
• L55.1 — Sunburn of second degree
• L55.2 — Sunburn of third degree
• L55.9 — Sunburn, unspecified.