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American Burn Association

Coding FAQs

February 2011

Q (1): Can I bill an evaluation and management (E&M) code with the debridement/dressing change code? A (1): Good question and not easy to answer. The procedure codes (16020 - 16030) are used to report the local treatment of the burn wound itself. These codes do not include evaluation and management services involving history, exam and medical decision making for concurrent systemic problems experienced by the patient. The usual pre- and post-procedural services (e.g., explaining procedures to the patient/family, supervising the positioning and prepping of patient; monitoring stability of the patient, as appropriate; and after care instruction) are included in the debridement/dressing CPT code and not reported separately. Be sure you have good documentation of a significant, separately identifiable E&M service to report this separate code. Do not forget to append modifier 25 to the E&M code when reported with a debridement/dressing change code. Q (2): I just heard that I can bill for a debridement or dressing change every day. I have not been billing this because I thought the dressing change was part of my E&M service. How would I have known this? A (2): The debridement/dressing change codes have a 0-day postoperative global period according to Medicare; therefore, your service may be reported on a daily basis when performed and documented. Medicare publishes the global period information on its website or you can use a resource such as the American Medical Association's Code Manager (www.codemanager.com) as a resource. Below is a screenshot from Code Manager for CPT 16020. The arrow is pointing to Medicare's global period, called "global surgery" information indicating there are 0-days in the postoperative global period.

Q (3): If I change dressings on two medium burn wounds located on separate extremities, should code 16025, dressings and/or debridement of partial-thickness burns, initial or subsequent; medium (e.g., whole face or whole extremity, or 5% to 10% total body surface area), be reported twice? A (3): No, only one code is reported. Add the body surface areas together and choose the single appropriate code to represent the total service provided. Codes (16020 - 16030) are to be used as a cumulative single code for each encounter to dress or debride burn wounds.

American Burn Association, 625 N. Michigan Ave., Ste 2550, Chicago, IL 60611

Tel: (312) 642-9260

email: [email protected]

Q (4): Do I have to debride in order to use codes (16020 - 16030) or can I use this code for a dressing change on a burn patient? A (4): The CPT codes state, "dressings and/or debridement of partial-thickness burns, initial or subsequent." The "and/or" in the descriptor means either one may be performed to qualify for use of the code. For example, a dressing change alone suffices for use of this code, as does a burn debridement alone. If both a debridement and dressing change are performed, the code is still reported once. Q (5): What if I take the patient to the operating room or do a burn dressing change under anesthesia isn't there a different CPT code for that? A (5): The burn dressing change/debridement codes (16020 - 16030) would still apply in this instance because the treated wound is a burn. Q (6): Can I bill for dressing changes postoperatively on a grafted area? A (6): The skin substitute and graft codes (15040 - 15430) have a 90-day postoperative global period so routine dressing changes are included in the global surgical package and not separately reported. If you have to take the patient back to the operating room to do a dressing change under anesthesia or conscious sedation, because of the extent of the graft and the patient's need for pain medication during the procedure, then you may report 15852, dressing change (for other than burns) under anesthesia (other than local). The use of this code is applicable because the dressing change is for care of the skin graft and not the burn. Remember to append modifier (58 to 15852) as this was a planned or anticipated procedure in the postoperative period of the graft surgery. Q (7): I am confused about the surgical prep for burn surgery codes (15002 - 15005) versus the burn debridement/dressing change codes (16020 - 16030). Can you explain? A (7): The table below describes some of the major differences between the codes. Please note that the CPT guidelines for the Surgical Preparation codes changed considerably in 2011. CPT Code(s) Debridement/Dressing Change 16020 16025 16030 Total body surface area. Surgical Preparation 15002/+15003 15004/+15005 15002/+15003 = Trunk, arms, legs. 15004/+15005 = Face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits. Square centimeters (sq cm) of wound or % of

Anatomic Area

Size Number of Codes

Percent (%) of total body surface area. Sum the total body surface areas of separate burns and report one code per treatment session. Services related to local treatment of burned surface not including skin grafts/substitutes. Examples include curettage and placement of an antibiotic or other cream. Intent is for wound to heal by secondary intention.

body area of infants and children.

Sum the wound area(s) for the applicable anatomic location(s). Services related to preparing a clean and viable wound surface for surgical placement of a graft, flap, skin replacement, skin substitute or negative pressure wound therapy. Intent is for wound to heal by primary intention or by the use of negative pressure wound therapy.

Primary Use

Wound Healing

Disclosure: The American Burn Association (ABA), in conjunction with Zupko & Associates, a consulting firm with broad expertise relating to coding issues, is providing this information as a service to ABA membership and their health care institutions. While every effort has been made to assure the accuracy of the information, both the ABA and Zupko & Associates provide no warranties and disclaim any liability relating to such information or its use.

American Burn Association, 625 N. Michigan Ave., Ste 2550, Chicago, IL

Tel: (312) 642-9260

email: [email protected]

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