There are several CPT codes related to burn coding available to enhance your coding and reimbursement. Burn coding is often forgotten in the physician practice setting, which results in leaving a lot of money on the table. These codes refer to local treatment of burned surface area only, what will normally be seen in a physician practice setting. When using these burns codes, remember to document percentage of body surface involved and degree or the depth of burn. Remember your "Rule of Nines" in calculating Total Body Surface Area!
Degrees of Burns (Depth of Burn)
There are a total of six degrees of burns. This article focuses on first and second degree burns and coding for a physician practice setting. Third through sixth degree burns are typically addressed in the hospital setting requiring fluids and extensive debridement, skin grafting and/or amputation; the latter two are usually fatal and the degrees are determined by autopsy.
A first degree burn is a superficial burn of the outermost layer of skin, or the epidermis. The kind of burn that can be categorized as first degree is a typical sun burn or being scalded with hot water from the sink. The skin turns red and there is no blistering. Though painful, the function of the skin is not compromised.
A second degree burn damages the second layer of skin, the dermis. These are "partial-thickness burns". Typical causes of second degree burns include contact with a hot iron (curling, flat, clothes), chemicals, and hot liquids, such as boiling water or coffee. An initial sign of second degree burn is blistering. Second degree burns are the most painful and there is an increased risk of infection, compared to a first degree burn. If the second degree burn covers a larger percentage of body area, emergency care may be needed due to the patient risk of going into shock and their need for fluids.
Rules of Nines (Body Surface Area)
There are several excellent charts that refer to the "The Rules of Nine" for burn coding. There is a Rule of Nines for adults and a different one for infants. Each area of the body has a percentage amount assigned and all the percentage amounts added together equal 100%.
Adult skin area percentages:
· Head and neck 9%
· Torso 36% (upper chest 9%, abdomen 9%, upper back 9% and lower back 9%)
· Arms 18% (each arm is 9% total, broken down further by anterior/posterior 4.5% each)
· Legs 36% (each leg is 18% total, broken down further by anterior/posterior 9% each)
· Perineum/Genital area 1%
Infant skin area percentages:
· Head and neck 21%
· Torso/Abdomen 13%
· Back 13%
· Buttocks 5%
· Each Arm 10%
· Each Leg 13.5%
· Perineum/Genital area 1%
A baby's body area is measured differently than an adult because its head and torso have more skin area than their appendages. A second degree burn, even at a lower percentage of skin area, presents a greater risk and requires more emergent care than an adult with the same type of burn.
CPT Coding for First and Second Degree Burns
· 16000 Initial Treatment, first degree burn, when no more than local treatment is required.
· 16020 Dressings AND/OR Debridement of partial thickness burns, Initial OR Subsequent; small (less than 5% total body surface area)
· 16025 Dressings AND/OR Debridement of partial thickness burns, Initial OR Subsequent; medium (e.g. whole face or whole extremity, or 5% to 10% of total body surface area)
· 16030 Dressings AND/OR Debridement of partial thickness burns, Initial OR Subsequent; large (e.g. more than one extremity, or greater than 10% of total body surface area)
CPT code 16000 is ONLY for the Initial Treatment, whereas CPT codes 16020, 16025 and 16030 are for Initial AND Subsequent visits. CPT does not specify a maximum level of subsequent visits; however, a specific health plan may have a maximum level.
Notice that CPT codes 16020, 16025 and 16030 state "Dressing AND/OR Debridement. It is appropriate to code these codes when patients are coming in specifically for dressing changes and the application of burn product, such as Silvadene cream (silver sulfadiazine).
Diagnosis Coding for Burns
The ICD-9 codes for burns can be found in the "Injury and Poisoning" Section, specifically in the 940-949 range of codes; however, sunburn codes (solar radiation) are coded with 692.71, 692.76-692.77. Burn codes from 940-946 involved specific body areas, including multiple sites. ICD code 948 is "Burns classified according to extent of body surface involved". The ICD notes, "This category is to be used when the site of the burn is unspecified, or with categories 940-947 when the site is specified." The code requires a fifth digit if the burn is Third Degree; otherwise, use the appropriate four digit code based on the percentage of burned body surface.
In addition to the above codes describing the type of burn and body area, there are a variety of "E-codes" to describe how the injury occurred. For example, E958.1, E968.0, and E988.1 are burns due to Fire. A burn caused by a hot liquid is E968.3.
These codes can be used in addition to an office visit; however, the office visit must be medically necessary and a modifier -25 must be appended to the office visit. An example of a medically necessary office visit would be to prescribe medications (such as antibiotics and/or pain medication, for example).
In summary, the documentation for burn coding requires the provider to record the percentage of body area burned and the depth of the burn. Though there is only one code for a first degree burn; a partial-thickness, second degree, burn may require more than one visit for debridement and/or dressing, therefore these codes can be utilized for both the initial visit as well as the subsequent visits.
Charlene Endre-Burgett, MS-HCM, CMA(AAMA), CPM-MCS, CPC, CMSCS has 26 years of health care office management experience, as well as 15 years of coding experience. She is the Administrator for North Scottsdale Family Medicine in Scottsdale, Arizona and is an AAPC member.
