Primary Care Coding Alert

Question:

Since the burn care involves treatment, you can report 16000 (Initial treatment, first degree burn, when no more than local treatment is required) for the burn care. You may report this in addition to a modifier 25 appended to the E/M service provided documentation supports a significant, separately identifiable E/M service, such as 99212-25 (Office or other outpatient visit for the evaluation and management of an established patient ...).

Code 16000 adds over $65 to the claim, according to the 2010 Medicare Physician Fee Schedule (1.78 total non-facility relative value units multiplied by the current 2010 Medicare conversion factor of 36.8729). 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 99212 (or other appropriate E/M service), and you should expect full pay for both the E/M service and sunburn care.