Burn Treatments: 16000-16030 May Not Tell Entire Burn Treatment Story

There's more to the procedures than dressing, debridement -- sometimes almost $900 more.

If you're reporting 16000-16036 codes, you might be forfeiting pay -- nearly $900 -- for separately reimbursable procedures, because procedures such as skin grafts are not included in these codes. Our coding experts offer these three tips for improving your burn treatment reimbursement.

Tip 1: Size Determines Anesthesia Code Choice

If the doctor only derides a burn, you should select an initial treatment code from the 16000-16030 series.

Here's why: Select 16000 (Initial treatment, first-degree burn, when no more than local treatment is required) when the physician tends to a first-degree burn only (burns affecting only the epidermis).

For more extensive burns, you must choose among codes 16020 (Dressings 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]), or 16030 (... large [e.g., more than 1 extremity, or greater than 10% total body surface area]).

Don't miss: To find the percentage of involved skin, use the “Rule of Nines," says Pamela Biffle, CPC, CPC-P, CPC-I, CCS-P, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Austin, Texas. According to the rule:

head and neck, the right arm, and the left arm each equal 9 percent

the back trunk, front trunk, left leg, and right leg each equal 18 percent (the front and back trunk are divided into upper and lower segments, and each leg is divided into back and front segments, each equaling 9 percent)

genitalia equals 1 percent.

Select the treatment code based on that percentage, says Biffle.

One more thing: Make sure the dermatologist clearly states the size of the affected area(s) in the documentation to support any code selection.

Tip 2: Claim Skin Grafts When Applicable

Codes 16000-16036 describe treatment of the burn surface only, so you may report skin grafts if the physician performs them. You should select the appropriate skin graft code(s) from the 15040-15431 portion of CPT-- not doing so could undermine your reimbursement and cause your practice to lose well-deserved pay.

Example: The doctor treats a patient with third-degree burns on the left arm. He uses a free, full-thickness graft of 40 sq cm to close the wound.

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