ED Coding and Reimbursement Alert

The edits, which took effect April 1, also tighten up vaccine coding The latest version of the National Correct Coding Initiative has some ED edits you won't want to miss -- particularly when your ED physician performs debridement and treatment on the same burn site.

-Most of these edits seem to be trying to capture redundant codes and reduce redundant coding,- says Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan. Burn and Debridement Bundles HIghlight This Quarter's NCCI NCCI 13.1 outlaws reporting a pair of debridement codes with certain burn treatment codes in most situations, Moore says.

NCCI reports that the following codes are bundled 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 one 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 reports to the ED for treatment of a small partial-thickness burn on his arm. During the encounter, the physician performs debridement on the burn before treating it. In this instance, the debridement is bundled into the burn treatment. Report 16020 for the encounter.

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, in which you could rightfully unbundle these edits and report a debridement and burn treatment code:

A 25-year-old male reports to the ED four days after sustaining grease burns while working as a cook. The left arm has a small second-degree burn, which the physician debrides and then treats with topical silvadene. The right arm has several large areas of infected necrotic skin from old injuries, likely resulting from several untreated lacerations. The physician debrides the infected skin on the right arm 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, says Michael Granovsky, MD, CPC, FACEP, vice president of MRSI, an ED coding and billing company in Woburn, Mass.

On the claim, 
 - report 16020 for the treatment of the left arm burn.

 - report 11000 [...]