Primary Care Coding Alert

Watch out: Latest burn edits allow possibility of unbundling 
 
The latest version of the Correct Coding Initiative (CCI), 13.1, has some edits coders won't want to miss -- especially when the FP treats burn patients.
 
13.1 Includes Burn and Debridement Bundles 
 
According to Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan., CCI 13.1 doesn't allow you to report a pair of debridement codes with certain burn treatment codes in most situations.
 
CCI bundles the following codes into 16020 (Dressings and/or debridement of partial-thickness burns, initial or subsequent; small [less than 5 percent total body surface area]), 16025 (- medium [e.g., whole face or whole extremity, or 5 percent to 10 percent total body surface area]) and 16030 (- large [e.g., more than 1 extremity, or greater than 10 percent total body surface area]):

 - 11000 -- Debridement of extensive eczematous or   infected skin; up to 10 percent of body surface

 - 11040 -- Debridement; skin, partial thickness. 
 
Explanation: -The burn code descriptions include debridement, so you should not report both codes- when treatment occurs on the same wound, Moore says.
 
For example, a patient has a small partial-thickness burn on his arm. The physician debrides the burn before treating it. In this instance, CCI bundles the debridement into the burn treatment, and you should report 16020 for the service. All of these burn/debridement edits contain a modifier indicator of -1.- The -1- means you can report both of these codes for the same encounter in certain situations -- and with modifier 59 (Distinct procedural service) attached to the component (bundled) code.
 
Consider this scenario from Bruce Rappoport, MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for Rachlin, Cohen and Holtz LLP, a Fort Lauderdale, Fla.-based accounting firm with healthcare expertise. In the following scenario, you could rightfully unbundle these edits and report a debridement and burn treatment code:
 
A 25-year-old male reports to the FP with grease burns he suffered while cooking at home. The left arm has a small second-degree burn, which the physician debrides and then treats. The patient also requests that the FP look at a laceration on his right leg that he has been treating himself at home without improvement.
 
The right leg has several large areas of infected necrotic skin from the laceration. The physician debrides the infected skin on the right leg and places the patient on oral antibiotics.
 
In this scenario, you can report the debridement and the burn treatment because the procedures occurred on different body areas. On the claim, you should report the following codes:

 - 16020 for treating the left arm burn.

 - 11000 for debriding the patient's infected skin on the right leg.

 - modifier 59 attached to 11000 to show that the burn treatment and debridement were separate services.