Primary Care Coding Alert

Question: A patient came in with severe windburn on her face and lips, and the provider prescribed a topical ointment. The patient said she had just returned home from a skiing weekend and had experienced windburn before, but not to this extent. Can I report L55.9 and 16000 even though the provider diagnosed windburn and not sunburn?

Ohio Subscriber

Answer: You should not use sunburn codes for windburn. Windburn is painful inflammation caused by prolonged exposure to cold, windy environments, and the symptoms present almost identically to sunburn. ICD-10 guideline I.C.19.d says that the burn codes are for “thermal burns, except sunburns, that come from a heat source, such as a fire or hot appliance.” Windburn clearly doesn’t fit that description, and using L55.9 (Sunburn, unspecified), which falls in the radiation-related disorders of the skin and subcutaneous tissue (L55-L59) category, would also not be appropriate, since it specifically refers to sunburn. There is no diagnosis code specific to windburn, so you are left with an “other specified” code such as L98.8 (Other specified disorders of the skin and subcutaneous tissue).

As for the procedure code 16000 (Initial treatment, first degree burn, when no more than local treatment is required), the scenario you describe does not indicate the provider treated the windburn. Rather, the provider diagnosed the condition and prescribed a topical treatment for home use. That being said, even if the provider had applied a topical ointment in the office, you still wouldn’t likely report 16000.

As noted, from a coding perspective, burns other than sunburns (and, presumably, windburns) are thermal burns from a heat source, which is not the case here. Although the October 2012 CPT^® Assistant, Volume 22, Issue 10, says “first-degree burns are superficial burns involving minimal tissue damage that is limited to the epidermis and characterized by erythema, tenderness, and mild swelling,” and those symptoms precisely describe symptoms of windburn, the injury itself isn’t technically classified as a burn.

Consequently, any topical treatment that might be performed in the office would fall within the code that represented the appropriate level of evaluation and management (E/M) service, such as 99212 (Office or other outpatient visit… straightforward medical decision making…).