ED Coding and Reimbursement Alert

Question: After a level-two ED E/M service, the physician performs local burn treatment with debridement of a second-degree burn on a patient's left forearm. The patient also is diagnosed with some small patches of first degree burns in the same area How should I order the diagnosis codes for this treatment?

Indiana Subscriber

Answer: When the patient suffers burns of differing severity in the same anatomical area, diagnosis coding rules require that you code the most severe burn first. On the claim, report the following:

• 16020 (Dressings and/or debridement of partial-thickness burns, initial or subsequent; small [less than 5% total body surface area]) for the burn treatment
• 99282 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity ...) for the E/M service
• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99282 to show that the E/M and the burn treatment were separate services
• 943.21 (Burn of upper limb, except wrist and hand; blisters, epidermal loss [second degree]; forearm) appended to 16020 and 99282 to represent the patient's second-degree burn
• 943.11 (Burn of upper limb, except wrist and hand; blisters, erythema [first degree]; forearm) appended to 16020 and 99282 to represent the patient's first-degree burn
• 948.00 (Burns classified according to extent of body surface involved; burn [any degree] involving less than 10 percent of body surface) appended to 16020 and 99282 to represent the extent of the patient's burns.