Primary Care Coding Alert

When a patient seeks treatment from the family physician for a minor burn, many offices code the encounter as an E/M visit. However, in most cases, the office can secure higher reimbursement by using the appropriate burn code (16000 series).

"Generally speaking, treatment codes pay better than E/M codes," says Emily Hill, PAC, president of Hill & Associates, a consulting firm in Wilmington, N.C., who works with physician practices on issues related to coding and compliance. Burn Codes Pay More Burn codes will typically result in higher payment than E/M codes for the type of burn injuries family physicians see in their offices, Hill says. For example, a patient seeks treatment for a first-degree burn from a hot-water spill. The coder should use 16000 (Initial treatment, first-degree burn, when no more than local treatment is required). This code has a relative value unit (RVU) of 1.79, for a (national, not adjusted for region) Medicare allowance of $68.48.

To reach that same payment level with an established patient using E/M coding, the coder would have to assign the higher-level 99214 (Office or outpatient visit, established patient), which has an RVU of 2.06 and a resulting Medicare allowance of $78.81. A minor hot-water burn would not usually require that level of examination, Hill notes, making reimbursement difficult. Payment for burn treatment codes is higher because, in addition to the physician's time, the RVUs take into account the practice expenses associated with treating the burn, such as nurses' time, dressings and other supplies, Hill says. When to Apply the Different Codes While 16000 is the correct code for initial treatment of a first-degree burn, several other codes apply for more extensive burns requiring dressings and/or debridement, Hill says. Because the size of the burn is key in determining which code to use, be sure the physician provides that information. For instance, a patient comes to the office with a second-degree leg burn from a motorcycle exhaust pipe. The proper code is 16020* (Dressings and/or debridement, initial or subsequent; without anesthesia, office or hospital, small), Hill says. With an RVU of 1.77, this code is comparable in reimbursement to the example above.

For larger wounds, the code is 16025* ( without anesthesia, medium [e.g., whole face or whole extremity]), with an RVU of 3.44, or 16030 ( without anesthesia, large [e.g., more than one extremity]), with an RVU of 4.64. Codes 16010 ( under anesthesia, small) and 16015 ( under anesthesia, medium or large, or with major debridement) aren't typically used in a family physician's office, Hill says, because they apply to procedures done under anesthesia, and a local anesthetic does not [...]