ED Coding and Reimbursement Alert

Question: A patient is brought to the ED via ambulance after standing too close to a Roman candle during an amateur fireworks show at a Super Bowl party. He is wheezing, complaining of chest pain, and has burns to his upper right arm. After a level-four E/M service that included chest x-rays and breathing tests, the physician diagnoses first and second-degree burns to the upper right arm. The physician performs debridement of the burns, which total 6 percent of total body surface area (TBSA); there is no mention of thirddegree burn. How should I code this scenario?

Florida Subscriber

Answer: You'll only report a single ICD-9 code for the burn; and be sure to line up the diagnosis codes with the proper services. On the claim, report the following:

• 16025 (Dressings and/or debridement of partial-thickness burns, initial or subsequent; medium [e.g., whole face or whole extremity, or 5% to 10% total body surface area]) for the burn treatment

• 943.23 (Burn of upper limb, except wrist and hand; blisters, epidermal loss [second degree]; upper arm) appended to 16025 to represent the patient's burns

• 948.00 (Burns classified according to extent of body surface involved; burn [any degree] involving less than 10 percent of body surface; less than 10 percent or unspecified) appended to 16025 to represent the extent and severity of the burns

• E923.0 (Accident caused by explosive material; fireworks) appended to 16025 to represent that fireworks caused the burns

• 99284 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: a detailed history; a detailed examination; and medical decision making of moderate complexity ...) for the E/M

• 786.50 (Chest pain, unspecified) appended to 99284 to represent the patient's chest pain

• 786.07 (Wheezing) appended to 99284 to represent the patient's wheezing

• 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 99284 to show that the E/M and the burn treatment were separate services

Explanation: You do not have to report the first-degree burn diagnosis in this case; when the same anatomic location has burns of varying degrees, the highest-degree burn takes precedence and you don't report the lowerdegree burn.