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Burn Guidelines

Proper coding for burns in emergency settings is crucial due to complex regulations and potential revenue loss. Specific CPT codes are provided for various burn treatments, and it is important to use the correct diagnostic and E/M codes with appropriate modifiers. Emergency department physicians should be aware that not all minor burns qualify for certain codes and must ensure distinct services are coded accurately.

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48 views2 pages

Burn Guidelines

Proper coding for burns in emergency settings is crucial due to complex regulations and potential revenue loss. Specific CPT codes are provided for various burn treatments, and it is important to use the correct diagnostic and E/M codes with appropriate modifiers. Emergency department physicians should be aware that not all minor burns qualify for certain codes and must ensure distinct services are coded accurately.

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ASHWINI
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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It is very important to remain very cautious when coding for burns in an emergency setting.

This is mainly because the medical coding rules and regulations for burn care are complex,
are subject to change often and errors can cause big revenue loss to your practice. When it
comes to proper coding, you should use the right diagnostic codes, CPT codes and
evaluation and management (E/M) codes with the correct modifiers.

There is a set of sub category codes (more specific codes) for each of the cases mentioned
above.

CPT codes

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

 16020: Dressings and/or debridement, initial or subsequent; without anesthesia,


office or hospital, small

 16025: Dressings and/or debridement, initial or subsequent; without anesthesia,


medium eg, whole face or whole extremity

 16030: Dressings and/or debridement, initial or subsequent; without anesthesia,


large eg, more than one extremity

 16035: Escharotomy

 16036: Escharotomy, each additional incision List separately in addition to code for
primary procedure

Tips for Coding Burn Treatment Services

Emergency Department (ED) physicians can follow these tips for coding burn treatment
services to ensure on-target coding as well as correct pay.

 Every minor burn presenting to the ED does not qualify for 16000-16030 service. For
certain minor cases (for example, sunburn), you can use emergency department E/M
code.

 If a patient comes to the ED with first-degree burn (affects the epidermis only), then
you should use 16000. You should also use the ED E/M code 99283 along with it. Add
the modifier 25 to the E/M code to specify that the E/M and burn treatment were
distinct services.
 If a patient comes to the ED with second degree burns – partial thickness, you can
use the codes 16020-16030. However, you should thoroughly check the chart for the
word blistering (either superficial, involving only the epidermis and superficial layers
of the dermis). Considering partial thickness codes is the key when the chart
mentions debridement.

A separate E/M service over and above the treatment is required for patients coming to the
emergency department for burn treatment. Though low level E/M services are provided to
most patients, there are instances when a high-level E/M service is provided apart from the
burn treatment. Physicians should assign appropriate codes according to this.

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