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tci ED Coding & Reimbursement Alert - 2000 Issue 5

Correct Coding of Critical Care Optimizes Billing Of Second- and Third-Degree Burn Injuries

ED coders must rely on specific physician documentation of medical history, physical examination of the burn and level of medical decision-making to assign the appropriate evaluation and management (E/M) code (99281-99285). Then, they must use the documentation of the physical examination and treatment to choose a burn treatment code (16000-16035, burns, local treatment) if applicable. Patients with larger second- and third-degree burns are more likely to require a higher level of care and additional procedures, which can increase the level of E/M code or even require critical care.If a burn is associated with a potential for respiratory injury...

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