ED Coding and Reimbursement Alert

-Rule of Nines- is not just for ICD-9 coding

Your physician will certainly treat her share of first- and second-degree burn patients. So you should focus on the ins and outs of coding these burn encounters.

Why? ED physicians rarely treat more-severe burns. When a patient reports with third- or fourth-degree burn, your physician will most likely examine the patient and call in a specialist to handle treatment.
 
Check for E/M on Burn Encounters
 
Burn patients who present to the ED almost universally receive a separate E/M service before burn treatment, says Maria Narvaez, RHIT, CCS-P, manager of coding operations at LifePoint Hospitals Inc. in Brentwood, Tenn.

-The E/M is necessary to assess patient condition prior to treatment,- Narvaez says. This E/M can include:

- determining the cause of the trauma,
- searching for any conditions that a patient might have that could interfere with treatment, or
- examination of the affected part necessary to determine the extent of burns and the degree of the burns. Best bet: Look for evidence of a separate E/M on each of your burn code claims. If you decide to file a separate E/M, be sure to attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the code to show that the E/M and burn treatment were separate services.

Example: A patient with burns on her lower left leg reports to the ED. The physician performs a level-two E/M and discovers first-degree burns on the leg, which he treats with cool towels, gauze and an application of topical antibiotics.

On this claim, you should report the following:

- 16000 (Initial treatment, first degree burn, when no more than local treatment is required) for the burn treatment
- 99282 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making of low complexity) for the E/M
- modifier 25 linked to 99282 to show that the E/M and burn treatment were separate services.
 
Exception: In rare instances, a patient might report to the ED for follow-up burn care (this may occur if the patient has no primary-care physician, for example). In these cases, the physician might perform burn treatment without documenting a separate E/M. Size Drives 2nd-Degree Burn Treatment Choice While you-ll report 16000 for all of the first-degree burns that the physician treats, selection of second-degree treatment codes is more involved. Characteristics: -Second-degree burns involve damage to the epidermis and the dermis (the second layer of skin, located beneath the epidermis), characterized by blistering, with red, moist skin,- says Caral Edelberg, CPC, CCS-P, CHC, president of Medical Management Resources for TeamHealth in Jacksonville, Fla.

If the [...]