Revenue Cycle Insider

Certain ED complaints are more common when the temperatures rise.

The temperature is up, school is out, and shoes are off. It’s not just the recipe for a summer picnic — these factors can also lead to a packed emergency department (ED). Even as summer presentations continue to rotate through your ED, you’ll need to keep getting your claims approved swiftly and without delay.

Check out three common summer presentations, along with expert tips on how to report these situations correctly every time. 

1. Check Sunburn Severity

Sunburns can range from mild to severe, and the treatment the ED physician uses will depend on how serious the burn is. While many sunburns can be treated with topical medications, some call for debridement and dressings. The key is to gauge the sunburn severity, which you can only do if the provider documents the visit thoroughly and records the degree of the burn.

First-degree burns only affect the surface of the skin, and if a sunburn patient is in this category, you’ll typically report burn code 16000 (Initial treatment, first degree burn, when no more than local treatment is required).

“Local treatment,” which 16000 describes, usually indicates the provider is applying some form of topical medication, such as aloe vera lotion or an antibiotic ointment. There is usually no dressing required for minor burns such as this.

Second-degree burns require more extensive treatment. Because they have gone below the surface of the skin and into the dermis, they are regarded as partial-thickness burns. This means that they have probably blistered, so the burn area will likely require debridement and dressing.

This will lead you to choose a code from the 16020-16030 (Dressings and/or debridement of partial-thickness burns, initial or subsequent ...) range. Your specific code choice will depend on your provider’s documentation of the amount of surface area affected, as the codes are size-dependent.

For instance, if the sunburn comprises less than 5 percent of the total body surface area (TBSA), you’ll report 16020 (... small (less than 5% total body surface area)).

Remember to apply the most accurate diagnosis code as well. Look to L55.0 (Sunburn of first degree) or L55.1 (Sunburn of second degree) to report the patient’s sunburn. Unlike the burn and corrosion codes (T20-T32), these codes are not site-specific.

If you’re tempted to use the T20.- (Burn and corrosion of head, face, and neck) series to code sunburns, think again. The 2025 ICD-10-CM Official Guidelines state that these codes apply to “thermal burns, except sunburns, that come from a heat source.” The sunburn exception means you should avoid them in these cases.

2. Allergic Reactions May Require Injections

Insect stings often accompany moments spent outside, from picking flowers to walking in the grass, and those moments typically increase as the weather warms. If you see patients with allergic reactions to bee stings or other outside forces, your provider may need to give them an injection. Which code you select may depend on the type of injection and which medication was administered.

For example: A patient presented to the ED after getting stung by a yellow jacket. Initially, they experienced swelling and redness, followed by wheezing and a drop in blood pressure. The provider injected 25 mg of diphenhydramine hydrochloride, but the patient then began drifting in and out of consciousness, and the physician determined the patient was in anaphylaxis. The physician administered 0.18 mg of epinephrine. The physician documented that they performed critical care, and the physician and the nurse monitored the patient for two hours on and off.

For this scenario, you should report two units of 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular) for the epinephrine injection and the diphenhydramine hydrochloride injection. Some payers require you to append modifier 59 (Distinct procedural service) to the second instance of 96372 to reflect that a second intramuscular or subcutaneous injection was administered.

To collect for the actual drugs that the ED physician administered, you should also report 18 units of J0171 (Injection, Adrenalin, epinephrine, 0.1 mg) for the epinephrine they administered. You’ll also report J1200 (Injection, diphenhydramine HCl, up to 50 mg) for the 25 mg of diphenhydramine hydrochloride.

The ED physician should also report 99291, (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and possibly 2 units of +99292 (... each additional 30 minutes (List separately in addition to code for primary service)), depending on the number of critical care minutes that the provider actually documented in the record.

3. Evaluate Dehydration Options

As the heat rises, patients may get dehydrated easily, and sometimes they won’t even realize it. These patients may present with symptoms like confusion, nausea, and fatigue, and it’s up to the ED physician to determine what’s ailing them. If dehydration is the definitive diagnosis, the provider is likely to perform intravenous (IV) hydration.

For instance, suppose a patient presents to the ED experiencing a headache, nausea, and vomiting. They think they may have food poisoning, but the provider diagnoses them with dehydration. The provider recommends IV hydration, but the patient is terrified of needles and asks if there’s another option. The provider says the patient can take sips of water while continuing to have his electrolyte levels monitored. After the patient’s labs indicate he is no longer experiencing dehydration, the patient is discharged from the ED. The provider documents a moderate level of medical decision making (MDM).

For this service, you’ll report 99284 (Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making) for the E/M visit. Because no IV hydration is used, the E/M should be the only code that applies. For your ICD-10-CM code, you should report E86.0 (Dehydration).

Torrey Kim, Contributing Writer, Raleigh, NC