Wiki Cpt code 16000

[mpmckenzie]

Hello I recently encounter an ER case where patient was seen and treated for sun burn due to tanning. The ER physician cleaned and dressed the burn so I suggested using CPT code 16000 as it was justified by documentation. Because this procedure code is used for 1st degree burns, is it ok to bill and get reimbursed for sun burn, if so please provide any regulatory/policy information to back this so I can present to my agency. thanks in advance

Michelle, CPC

 

[mlenzi]

16000 is correct as it goes by the depth of the of the care
According to Encoder this is what is treated.

This procedure refers to the local treatment of the burned surface only. List the percentage of total body surface area (TBSA) involved. Initial treatment of first-degree burn is defined as the symptomatic treatment of pain and tenderness. When calculating percentage of a body surface area burned, refer to the "Rule of Nines" for appropriate patient age as the infant or child deviates because of the large surface area of the child's head.

 

[mpmckenzie]

Thank you I did group it and there was no edits however the person who coded it states that the treatment was not for a 1st degree burn and I'm just the Auditor so unless I can provide some type of regulatory information its money lost:

 

[mitchellde]

Sun burns are not coded to body percentage and have their own codes as sun burns not trauma burns. If the dx code is correct as a sum burn it may not match to the procedure of 16000 for medical necessity. So check your dx code before you look for the edit. If the dx code is correct for sun burn and it does not reject for medical necessity then it is probably a good match.

 

[Cynthia Hughes]

You can find a reference to support use of code 16000 in the treatment of a sunburn in CPT Assistant of October 2012.