General Surgery Coding Alert

Pick Dx first to zero in on local treatment codes.

Grills, fireworks, lightning, sunburn ... along with summertime fun you're likely to see an uptick in burn patients in your practice this time of year.

But you won't see an uptick in revenue if you only report the E/M service and miss up to $165 for dressing and debridement of the burn site.

General surgeons are often the first line of care for burns, according to M. Tray Dunaway, MD, FACS, CSP, a surgeon, author, speaker, and coding educator with Healthcare Value Inc. in Camden, S.C. "We're the ones they call to the ER to assess the patient and provide initial treatment before we ship them to the burn center," he says.

Report Burns by Size, Location, Severity

Because CPT bases some burn treatment codes on the extent of burns (small, medium, or large), you have to determine the burn diagnosis before selecting the procedure code.

Burn cases will always have at least two diagnosis codes. The first code, which represents the location and severity of the patient's burn, should come from the 940.x-947.x series. Know burn severity: Your surgeon will assess burn severity as first, second, or third degree burns.

"A first-degree burn usually only reddens the skin," explains Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians. "Any swelling or mild blistering usually is nominal and resolves quickly."

In contrast, second-degree (partial thickness) burns affect both the outer and underlying skin layers. They cause pain, redness, swelling, and extensive blistering. Third-degree (full thickness) burns extend into deeper tissues. They cause white or blackened, charred skin that may be numb because the burn trauma has destroyed the nerve endings.

Determine TBSA next: The second diagnosis code you'll need comes from the 948. xx series. This code represents the total body surface area (TBSA) affected. Base Local Treatment Code on TBSA and 'Degree' When your surgeon dresses or debrides a burn site, the ICD-9 codes provide the information you need to choose the appropriate procedure code from the following list:

16000 -- Initial treatment, first degree burn, when no more than local treatment is required

16020 -- Dressing and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5 % total body surface area)

16025 -- ... medium (e.g., whole face or whole extremity, or 5% to 10% total body surface area)

16030 -- ... large (e.g., more than 1 extremity, or greater than 10% total body surface area). This code has the highest reimbursement -- $129.44 for the nonfacility national rate using conversion factor 28.3868

Example: A patient presents with severe sunburn on his back and the back of his legs and arms. "Besides diagnosing the sunburn -- which is a first degree burn -- the physician might treat it with a cold, wet compress on the area and report 16000," says Richard Lander, MD, FAAP, a clinical assistant professor at University of Medicine and Dentistry of New Jersey. You might also report 16000 when the physician applies topical anesthetic or other local treatment options.

Caveat: If the physician assesses the burn and then instructs the nurse to dress the wound, you cannot report a burn care code. Report only an E/M code if the physician doesn't provide the burn care.

Look for Separate E/M Services

The surgeon will often perform a separately identifiable E/M service in addition to the burn treatment. For instance, the surgeon might evaluate a patient for dehydration and heart problems as well as evaluating the local burn site, according to Dunaway.

In this case, you could report an E/M code, such as 99202 (Office or other outpatient visit for the evaluation and management of a new patient ...) separate from the burn treatment code.

Caution: If the surgeon's note identifies only service directed at treating the burn, don't list a separate E/M code.

There is no typical level of service for burn E/M encounters; it all depends on the type and severity of the burn and what systems the physician examines.

Don't miss: If you're reporting a burn treatment from the range 16000-16030 with an E/M procedure, you'll need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code to show that it was a separate service from the burn care.