Primary Care Coding Alert

Here’s why you need to remember the acronym S/S.E.E.

Once you’ve answered the quiz questions on page 3, compare your answers with the ones provided below:

Answer 1: “For very minor burns that really require no treatment, many providers might decide to only bill an evaluation and management (E/M) code as there is little actual treatment provided for a first-degree burn,” says Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington.

In this encounter, that would probably mean coding 99202/99212 (Office or other outpatient visit for the evaluation and management of a new/established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making …) based on a single, self-limited, or minor problem and a minimal risk of complications from treatment.

ICD-10 coding for this encounter is more complex. That’s because “You need at least three codes to properly report these diagnoses, which you can remember with the acronym S/S.E.E.,” says Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting, Inc. in Lansdale, PA.

“You’ll choose the first listed code from categories T20-T25 (Burns and corrosions of external body surface, specified by site) based on the Severity/Site of the burn(s). The next listed code, from code category T31 (Burns classified according to extent of body surface involved), will describe the condition’s Extent. And the final code will be from Chapter 20 (External causes of morbidity) and will describe the condition’s External cause,” Falbo elaborates.

Using this acronym on this encounter, your coding should look something like this:

• T24.112A (Burn of first degree of left thigh, initial encounter)
• T31.0 (Burns involving less than 10% of body surface)
• X10.0XXA (Contact with hot drinks, initial encounter)

Why T31.0? The hardest part of burn coding involves calculating the amount of body surface area that has been burnt. One of the most detailed, and age-specific, ways to do this is the Lund-Browder classification method. This has the added advantage of being the system referenced by CPT^®. Using this method, a burn of an adult’s entire left thigh is classified as 9-1/2 per cent of the total body area. This is less than 10 per cent, so T31.0 is the correct ICD-10 code to use to document the extent of the patient’s body surface affected by the burn.

Answer 2: In this case, even though the burn was also superficial and involved only the layers of the dermis, the provider decided to treat the wound as the patient’s diabetes could negatively impact wound healing. This means you will use 16000 (Initial treatment, first degree burn, when no more than local treatment is required) rather than an office/outpatient E/M code to describe the treatment. If the provider performed necessary and related medical services to the patient that are significant and separately identifiable from the treatment, you may also report an appropriate E/M code in addition to 16000, appending modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M code.

ICD-10 coding in this encounter would look like this:

• T23.152A (Burn of first degree of left palm, initial encounter)
• T31.0 (Burns involving less than 10% of body surface)
• X16.XXXA (Contact with hot heating appliances, radiators and pipes, initial encounter)

Answer 3: In this example, the Lund-Browder classification tells you that the burn to the 15-year-old’s back represents approximately 13 per cent of the child’s body, or greater than 10 per cent of his total body area. Knowing this, and knowing that a second-degree burn goes below the dermis and will produce blisters that will require your provider to debride and dress the wound, will lead you to code 16030 (Dressings and/or debridement of partial-thickness burns, initial or subsequent; large (eg, more than 1 extremity, or greater than 10% total body surface area)).

The Lund-Browder classification also helps you pick out the correct ICD-10 coding, but as the burn occurs over the entire back, you will need two codes to document the injury:

• T21.23XA (Burn of second degree of upper back, initial encounter)
• T21.24XA (Burn of second degree of lower back, initial encounter)
• T31.10 (Burns involving 10-19% of body surface with 0% to 9% third degree burns)
• X03.0XXA (Exposure to flames in controlled fire, not in building or structure, initial encounter)

Why X03.0XXA? The parent code notes to X03 tell you that the codes include exposure to a bonfire or campfire.

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