Dont Get Burned by Overlooking the 16000 Series
Published on Tue Jan 01, 2002
Legitimate opportunities for increased ethical revenue are being lost if emergency department coders don't recognize when they may report burn treatment services provided by physicians, according to Kenneth De Hart, MD, FACEP, president of Carolina Health Specialists in Myrtle Beach, S.C. "Based on my experience, there are many emergency departments in many parts of the country that fail to recognize when the 16000-16030 series may be invoked and, therefore, these codes are vastly underutilized," he says.
Instead, coders often assign only emergency visit codes (99281-99285) to report burn treatment, resulting in lower payments. For example, the fully implemented facility total relative value units (RVUs) for a level-three ED code (99283), according to the 2002 Physician Fee Schedule, is 1.60. On the other hand, the RVU for 16025* (dressings and/or debridement, initial or subsequent; without anesthesia, medium [e.g., whole face or whole extremity]) is 2.70.
The codes from the burn series most often used in an emergency department are 16000 (initial treatment, first degree burn, when no more than local treatment is required), 16020* (dressings and/or debridement, initial or subsequent; without anesthesia, office or hospital, small), 16025* and 16030 ( without anesthesia, large [e.g., more than one extremity]). Other codes in the series require the use of anesthesia and, most often, other specialists would be called to handle cases of this nature.
According to Tracie Christian, CPC, CCS-P, director of coding for ProCode in Dallas, 16000 is being used now more than it was in the past. "Not too long ago, this code could not be reported when only dressings were applied to a burn. The code description was changed, however, to read 'dressing and/or debridement.' This allows us to appropriately report this code more frequently," she says.
Note: Burn treatment codes are reported only when the physician personally provides the service. If the physician simply assesses the burn and a nurse dresses it, only an E/M code may be reported for the assessment.
Apply the 'Rule of Nines'
When determining whether a burn is small, medium or large, apply the Rule of Nines. Charts demonstrating how this concept applies to both an adult's and a child's body can be found in the CPT manual adjacent to the 16000 code series. The rule allows physicians and coders to calculate the total body surface area (TBSA) affected by the burn by dividing the body into 9 percent increments. Three adult body areas are considered to each equal 9 percent the head and neck, the right arm, and the left arm. The back trunk, front truck, left leg and right leg are each considered to equal 18 percent. The perineum equals 1 percent TBSA. The front and back trunk, and each leg, may be divided into upper [...]
