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Summer Fun: Be Aware of Sunburns

Coding


Summer Fun: Be Aware of Sunburns

Date Posted: Tuesday, July 19, 2022

 

Summary: As UV rays are strongest during summer months when the sun is directly overhead, spending more time outdoors can result in sunburns.
 
Summer is the time for indulging in fun days at the beach and engaging in other outdoor activities. Enjoy your summer days outside but be very aware of the risks of sunburn. It is much easier to get a sunburn in the summer, as the sun's UV emissions are most intense during this time. Sunburn, or erythema, refers to the inflammation of the skin, caused by excessive exposure to ultraviolet radiation (UVR). The use of indoor tanning beds or overexposure to outdoor sunlight could even develop skin blisters. It is important to take the necessary steps to prevent excessive UV exposure, which could result in painful sunburns. You may think the only risk for this is when you are in direct sunlight, but even cloudy days can cause sunburns. 

Ultraviolet rays (UV) can come from the sun, tanning beds, or sunlamps. Overexposure to ultraviolet radiation without proper protection can cause skin damage. Too much exposure to the sun's ultraviolet rays is also the leading cause of skin cancer, making it critical to protect the skin from the sun.

UV rays cause the skin to produce the pigment melanin, which is meant to help block the sun's rays from causing damage. But when the body doesn't make enough melanin to provide this layer of protection to the skin, it can leave you vulnerable to sunburn.
General symptoms of a sunburn can include the skin being irritated, blistered, painful, and itchy. Redness usually appears within a few hours after excessive exposure to UV rays, and more symptoms may appear 12–24 hours after exposure. In severe cases, the skin may even peel and flake over a week's time. Treatments for a sunburn don't exactly heal the skin, but can reduce symptoms, such as pain, swelling, and discomfort. Sunburns can vary from mild to severe. While some burns are considered only minor and can be treated at home, others can cause lasting damage to your skin that may require long-term medical care.

Check Out These Numbers

Skin cancer is the most common cancer in the U.S., affecting one in five Americans in their lifetime, due to the following reasons:
  • Most Americans aren't taking the proper precautions to protect themselves from the sun's harmful ultraviolet rays as per the AAD (American Academy of Dermatology).
  • More than 1 out of every 3 Americans report getting sunburned each year (HHS.gov). Sunburn is a clear sign of overexposure to UV rays, and a major cause of skin cancer.

Sunburn Degrees

Doctors categorize burns based on the damage they cause to the skin and surrounding tissue. Sunburn can be considered first, second, or third degree, depending on the depth and size of the affected area of skin.

First degree

First degree or superficial sunburn is the least harmful, as it affects only the outer layer of the skin (epidermis) and can usually be treated at home. This burn may make the skin red, dry, and painful when you touch it. This common sunburn type often heals within 3 to 6 days. Symptoms usually occur about 4 hours after exposure to sunlight and will usually heal by itself, within a week.

Symptoms may include:
  • Pain and redness
  • Soreness
  • Swelling 
  • Blistering
  • Skin peeling in 1 to 2 days
  • Headache
  • Fatigue
  • Nausea

First degree burns can be easily treated at home. Remove the clothes that cover the burned area, apply cold and/or wet compressions, clean the area with mild soap and water, take over the counter (OTC) pain relievers if necessary, and drink plenty of fluids to avoid dehydration. Seek proper medical care if there are no signs of healing after 48 hours.

Second degree

Referred to as a superficial partial-thickness burn, this sunburn often damages the top two layers of skin – the epidermis and dermis, as well as nerve endings. More painful than first-degree burns, these may even need a skin graft and typically leave scars.

Treatment from a primary care physician, emergency room doctor, or a dermatologist will be required and this burn may take several weeks to heal.

Key symptoms include:
  • Deep redness
  • Blisters
  • Discolored skin
  • Swelling
  • Wet-looking, shiny skin

Other symptoms, such as dizziness, muscle cramps, fast breathing, or nausea may occur in cases of deep burns. While superficial second-degree burns usually heal in about three weeks, deep second-degree burns may take much longer to heal.

Treatment options include antibiotic medications, ointments, daily cleaning of the wound, and dressing changes, which all depends on the severity of the burn. 

Third degree

More severe than first or second-degree burns, these are full-thickness burns that destroy the skin and damage all layers of the skin along with the underlying tissue and will require skin grafts. This degree of burn oftentimes damages nerve endings in the skin that are responsible for sensing pain, leaving the area sensation-free.

Major symptoms of third-degree burn include:
  • Numb skin 
  • Dry and leathery skin
  • Swelling
  • White/waxy skin color
  • Little to no pain as the nerves are damaged
  • Tissue damage

Third degree burns may take several weeks or longer to heal. This level of burn often comes with severe complications. Skin grafting will be required, which involves a surgeon removing dead skin and then transferring healthy skin from another area of the body to the treatment site. Other treatment options include pain medications, nutritional supplements, a high-protein diet, and functional and cosmetic reconstruction. 

Treatment mainly depends on the location, severity, and extent of the sunburn. Immediate medical attention will be necessary for third-degree burns.

Coding Sunburns on the Medical Claims

ICD-10 codes
  • L55 Sunburn
    - L55.0 Sunburn of first degree
    - L55.1 Sunburn of second degree
    - L55.2 Sunburn of third degree
    - L55.9 Sunburn, unspecified

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; e.g., whole face or whole extremity
  • 16030: Dressings and/or debridement, initial or subsequent; without anesthesia, large; e.g., more than one extremity

E/M codes for Emergency Department
  • 99281: Emergency department visit for the evaluation and management of a patient, which requires these 3 key components:
    - A problem focused history;
    - A problem focused examination; and 
    - Straightforward medical decision making

Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor.

  • 99282: Emergency department visit for the evaluation and management of a patient, which requires these 3 key components:
    - An expanded problem focused history;
    - An expanded problem focused examination; and 
    - Medical decision making of low complexity.

Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity.

  • 99283: Emergency department visit for the evaluation and management of a patient, which requires these 3 key components:
    - An expanded problem focused history;
    - An expanded problem focused examination; and 
    - Medical decision making of moderate complexity.

Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity.

  • 99284: Emergency department visit for the evaluation and management of a patient, which requires these 3 key components:
    - A detailed history;
    - A detailed examination; and 
    - Medical decision making of moderate complexity.

Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and require urgent evaluation by the physician but do not pose an immediate significant threat to life or physiologic function.

  • 99285: Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status:
    - A comprehensive history;
    - A comprehensive examination; and 
    - Medical decision making of high complexity.

Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and pose an immediate significant threat to life or physiologic function.

It is important to report the burns, diagnosis, and treatments on the medical claims using accurate diagnosis and procedure codes to ensure proper reimbursement from insurers.

Skin Cancer and Sunburn

Exposure to UV rays over time can potentially cause damage to your DNA, which can then contribute to skin cancers, including deadly melanoma.

Sunburns are the leading cause of major skin cancers, such as basal cell carcinoma, squamous cell carcinoma, and melanoma. Skin cancer is the most diagnosed cancer in the United States, with around 5 million people treated each year. 

HHS has reported that more than 400,000 cases of skin cancer, about 6,000 of which are melanomas, are estimated to be related to indoor tanning in the U.S. each year. Sun exposure can also lead to other conditions, such as cataracts and cancer of the eyelids.

Preventing Sunburns

The following are the CDC (Centers for Disease Control and Prevention) recommendations to protect the skin from the sun:
  • Stay in the shade of an umbrella, tree, or other shelter, to reduce the risk of sun damage and skin cancer.
  • Use sunscreen and/or wear protective clothing when outside—even when in the shade.
  • Wear long-sleeved shirts and long pants or skirts that provide protection from UV rays.
  • Wear a T-shirt or a beach cover-up made of tightly woven fabric.
  • Wear a hat that has a brim all the way around that shades your face, ears, and the back of your neck.
  • Wear sunglasses to protect your eyes from UV rays and reduce the risk of cataracts. They also protect the tender skin around your eyes from sun exposure.
  • Use sunscreen that blocks both UVA and UVB rays and has an SPF of 15 or higher before going outside. 

First Aid
  • Clean the area with cool tap water or take a cool bath.
  • Apply a moisturizer, lotion, or gel for soothing effect.
  • Drink plenty of water to prevent dehydration.
  • Use over-the-counter hydrocortisone cream.
  • Avoid breaking small blisters and clean any broken blisters gently with mild soap and water.
  • Take pain relievers, such as ibuprofen or other non-steroidal anti-inflammatory medications.
  • Avoid further sun exposure while your skin is healing from the sunburn.

Spending time outside is a great way to keep physically active. Just make sure to protect your skin by taking the proper preventative steps against sunburns. 

Amber Darst is a Solutions Manager in the Practice and Revenue Cycle Management Department for Managed Outsource Solutions.  She brings several years of healthcare experience to the company, specializing in both Medical and Dental billing and insurance verification services.  www.managedoutsource.com



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