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.

Article Source :- http://www.supercoder.com/coding-newsletters/my-dermatology-coding-alert/burn-treatments-16000-16030-may-not-tell-entire-burn-treatment-story-107505-article

Closures: 12001 or 13100? Consider More Than Layers to Code Correct Closure Level

Follow our tips to dig deeper and find the differences between 'simple,' 'intermediate,' and 'complex.'

All closures aren't created equal; one of the nuances of coding these procedures is knowing how to distinguish one type from another. Read on for our experts' advice on how to assess the three closure levels and assign the best codes.

Remember 'Simple' Doesn't Mean 'Easy'

A simple repair involves primarily the dermis and epidermis. It might involve subcutaneous tissues, but not deep layers.

Draw the line: How do you know when a closure might involve subcutaneous layers but is still considered a simple repair? Your provider's documentation is the key. The difference is whether the wound is closed in layers or just a single layer, experts note. The provider might decide to include the subcutaneous layer in the closure but does so by bringing the needle through the dermis into the subcutaneous and back. That results in a single-layer closure rather than closing the subcutaneous layer first and then the dermis/epidermis second in separate closure techniques.

But "simple" doesn't mean the repair is something anyone could do. Simple repairs involve one-layer closure, which helps set them apart from a standard E/M procedure. Simple repair also includes "local anesthesia, and chemical or electrocauterization of wounds not closed," says Dilsia Santiago, CCS, CCS-P, a coder in Reading, Pa.

For example, if your dermatologist uses adhesive strips to close a laceration, consider it an E/M service that you'll report with the best-fitting choice from CPT codes 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient) or 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient). Most Steri-strip applications are done by nursing staff; but even if the physician applies them, they're included in the E/M service .

If, however, your dermatologist uses sutures, staples, or tissue adhesives to close the laceration, consider it a separate procedure. Choose your code from 12001-12007 (Simple repair of superficial wounds of scalp, neck, axillae, eternal genitalia, trunk and/or extremities [including hands and feet]) or 12011-12018 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes), based on the lesion's location and size.

Measuring tip: For excision of soft tissue tumors, measure the longest dimension of an oblong mass, according to John P. Heiner, MD, professor at University of Wisconsin Hospital and Clinics in Madison.

Medicare exception: Guidelines change when your physician performs a single-layer laceration repair on a Medicare patient. You'll report G0168 (Wound closure utilizing tissue adhesive[s] only) instead of reporting standard CPT codes. If your physician uses sutures instead of tissue adhesive for Medicare patients, turn back to the standard suture/repair codes.

Source URL :- http://www.supercoder.com/coding-newsletters/my-dermatology-coding-alert/closures-12001-or-13100-consider-more-than-layers-to-code-correct-closure-level-article


Jerry Salley, CPC, has over six years' experience writing about coding, focusing especially on ophthalmology coding with The Coding Institute's Ophthalmology Coding Alert . He has also written about optometry, gastroenterology, dermatology, audiology, and urology coding, as well as Joint Commission accreditation, healthcare human resources, and behavioral healthcare reimbursement issues. A graduate of Furman University, Jerry is a certified professional coder through the American Academy of Professional Coders.

Diagnosis Coding: Follow These 4 Steps to Master 940-949 Burn Diagnoses

Proper ICD-9 coding for burn patients can require several codes.

Dermatology coders who cannot choose the proper diagnosis codes for each burn treatment patient could end up costing their practices time and money.

How? Let's say your dermatologist provides local burn treatment for a patient (16000, Initial treatment, first degree burn, when no more than local treatment is required). If the claim contains an inaccurate burn diagnosis code, or no diagnosis code at all, the insurer could deny claims for burn treatment based on lack of medical necessity. Snuff out potential denials by following these four quick steps to picking the perfect burn diagnosis codes for each burn treatment encounter.

Step 1: Check Notes for Location of Burn

When choosing a burn diagnosis code, you first need to check the anatomic location of the burn, confirms Kevin Arnold, CPC, director of compliance for LYNX Medical Systems, based Washington. If you have notes indicating the anatomy of the burn, you'll first choose a burn diagnosis code from the 940.x (Burn confined to eye and adnexa …) to 947.x (Burn of internal organs …) code set.

The first three digits of the 940.x-947.x codes “refer to the general anatomic location of the burn. The fourth digit refers to the degree of the burn, with the fifth digit being the most specific anatomic location of the group," says Arnold. Not all of the codes in this diagnosis set have fifth-digit requirements, but you must code to the fifth digit if the code specifies it.

Example: The dermatologist treats a patient with first degree burns on his left foot. On the claim, you would report 945.12 (Burn of lower limb[s]; erythema [first degree]; foot) to represent the patient's condition.

If you have no evidence of burn location in the notes, choose a code from the 949.x code set instead, explains Jeffrey Linzer Sr., MD, FAAP, FACEP, Associate Medical Director for Compliance, Emergency Pediatric Group, Children's Healthcare of Atlanta at Egleston.

For example, operative notes indicate that a patient suffered second-degree burns, but there is no indication as to the anatomical location of the burn. For this claim, you would choose 949.2 (Burn, unspecified; blisters, epidermal loss [second degree]) as a diagnosis code.

Step 2: Ensure You've Coded for All Burns

You'll also need to make sure that you are coding for each burn the patient suffered. How many codes you include to represent the patient's injuries depends on encounter specifics.

Article Source :- http://www.supercoder.com/coding-newsletters/my-emergency-medicine-coding-alert/diagnosis-coding-follow-these-4-steps-to-master-940-949-burn-diagnoses-article