Get the proper reimbursement for burn treatment in the physician’s office.
First-Degree Burns A first-degree burn refers to a burn injury where the surface of the skin is damaged, but the epidermis (the outermost layer of skin) is still intact, and therefore able to perform its functions (control temperature and protect from infection or injury). A first-degree burn is considered a superficial burn. The differences between burn degrees have to do with the depth of the burn. It's the thickness of the skin that was injured. If only the surface of the skin, the top layer, was burned, we call that a first degree. 1 First degree burns have these signs.
By Charlene Endre-Burgett, MS-HCM, CMA, CPC, CPM-MCS, CMSCS
How often does your practice see a patient with the common sunburn? Or, someone whose burn resulted in a blister? Burn coding is often forgotten in the physician practice setting, which leaves money on the table. A review of types of burns commonly seen in a physician practice, and some quick tips, will help you reclaim your rightful reimbursement.
Degrees of Burns (Depth of Burn)
There are six degrees of burns. We’ll focus on first- and second-degree burns and coding for a physician practice setting.
A first-degree burn is a superficial burn of the outermost layer of skin, or epidermis. Examples include sunburn or being scalded with hot water from the sink. The skin turns red and there is no blistering. Although 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 include contact with a hot iron, chemicals, or boiling liquids. 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 large percentage of body area, emergency care may be needed due to the patient’s risk of going into shock and need for fluids.
Third- through sixth-degree burns are typically addressed in the hospital setting, and require fluids and extensive debridement, skin grafting or amputation; the latter two burn degrees are usually fatal, and are determined by autopsy.
Rule of Nines (Body Surface Area)
Burns are categorized by percentage of body area. For example, “he has a second-degree burn over 30 percent of his body” is a common way to describe a burn. Percentages are determined using “The Rule of Nines,” and knowing this rule is essential for CPT® and ICD-9-CM coding of second-degree and higher burns.
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 for an adult with the same type of burn. Each area of the body has a percentage amount assigned, and all the percentage amounts added together equal 100 percent (see Rule of Nines illustrations for percentage breakdown).
CPT® Coding for First- and Second-degree Burns
To determine a CPT® code for burn treatment, the medical record must document the degree of the burn and the percentage of body area affected. For second-degree burns, it’s important to document information on what is done during the visit because burn coding can be used for a dressing change or debridement.
Typical procedure codes include:
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 (eg, 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 (eg, more than 1 extremity, or greater than 10% of total body surface area)
CPT® code 16000 is for initial treatment only, whereas codes 16020, 16025, and 16030 are for initial and subsequent visits. CPT® does not specify a maximum number of subsequent visits; however, a specific health plan may have a maximum number.
Note that 16020, 16025, and 16030 state “dressing and/or debridement.” It is appropriate to report these codes when patients are coming in specifically for dressing changes and the application of a burn product, such as Silvadene cream (silver sulfadiazine).
Burn treatment codes can be used in addition to an office visit; however, the office visit must be medically necessary and modifier 25 Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service must be appended to the office visit. A separate, medically necessary office visit might occur, for instance, to prescribe medications such as antibiotics and pain medication.
Coding example: A wheelchair-bound patient presents to the office after dropping a pot of boiling water onto her lap. Exam reveals second-degree burns on both upper legs—anterior and posterior—and on the genital area. Areas are dressed with Silvadene cream and bandages. Patient is told to return in three days for possible debridement, along with dressing change. Patient is prescribed medication for pain management.
To calculate the percentage of area burned, total both upper legs for 18 percent (9 percent for the upper portion of each leg) and add an additional 1 percent for the genital area. A total of 19 percent of body area is affected.
CPT® code 16030 is appropriate in this example because these are partial thickness burns covering more than one extremity or 10 percent of body area. Depending on the provider’s documentation, an evaluation and management (E/M) code in the 9920x-9921x series is also appropriate when appended with modifier 25.
CPT® does not specify a maximum level of subsequent visits; however, a specific health plan may have a maximum level.
Diagnosis Coding for Burns
ICD-9-CM codes for burns can be found in the “Injury and Poisoning” section, specifically in the 940-949 range (except for sunburn: see the “Code Sunburns with Accuracy” infobox). Burn codes from 940-946 involve specific body areas, including multiple sites.
For code 948 Burns classified according to extent of body surface involved, the ICD-9-CM codebook instructs, “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.
The appropriate diagnosis codes for our example above, for instance, would be:
946.2 Blisters, epidermal loss [second degree]
948.1 Burns classified according to extent of body surface involved; 10-19 percent of body surface [a fifth digit is not appropriate in this case because this is not a third-degree burn]
E Codes Add Precision
In addition to the codes describing the type of burn and body area, a variety of E-codes may be called upon 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 in an assault is coded to E968.3 Assault by hot liquid. Or, an accidental burn by hot liquid (as in our example) would be identified with E924.0 Accident caused by hot substance or object, caustic or corrosive material, and steam; hot liquids and vapors, including steam.
Charlene Endre-Burgett, MS-HCM, CMA, CPC, CPM-MCS, 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, Ariz.
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1 Degree Burns Photo
What is a burn?
A burn occurs when heat, chemicals, sunlight, electricity or radiation damages skin tissue. Most burns happen accidentally. There are different degrees of burns. Your healthcare provider determines the seriousness (degree) of a burn based on the depth of the burn and the amount of affected skin. Burns can be painful. Left untreated, a burn can lead to infection.
How common are burns?
Close to half a million people go to the emergency department every year with burn injuries. Children are at high risk for accidental burns. Every day, more than 300 children receive emergency treatment for burn injuries.
Who might get a burn?
Accidental burns can happen to anyone, although children, teenagers and older people are most at risk. These age groups are more prone to burn injuries from cooking, such as spilling a boiling pan of water onto skin. Children and teens are also more likely to mess around with lighters, matches and fireworks or get sunburns.
What are the types of burns?
Healthcare providers classify burns by degrees of severity. Your provider will evaluate the extent of skin damage. Burn degrees include:
- First-degree burns are mild (like most sunburns). The top layer of skin (epidermis) turns red and is painful but doesn’t typically blister.
- Second-degree burns affect skin’s top and lower layers (dermis). You may experience pain, redness, swelling and blistering.
- Third-degree burns affect all three skin layers: epidermis, dermis and fat. The burn also destroys hair follicles and sweat glands. Because third-degree burns damage nerve endings, you probably won’t feel pain in the area of the burn itself, rather adjacent to it. Burned skin may be black, white or red with a leathery appearance.
Symptoms and Causes
What causes burns?
Many things can cause a burn. Thermal sources, including fire, hot liquids, steam and contact with hot surfaces, are the most common causes of burns. Other causes include exposure to:
- Chemicals, such as cement, acids or drain cleaners.
- Sun (ultraviolet or UV light).
What are the signs of burns?
Burn symptoms vary depending on the severity or degree of the burn. Symptoms are often worse during the first few hours or days after the burn. Burn symptoms include:
- White or charred (black) skin.
- Peeling skin.
Diagnosis and Tests
How are burns diagnosed?
Your healthcare provider will examine the burn to determine the degree or severity. This process involves estimating the percentage of the body affected by the burn and its depth. Your provider may classify the burn as:
- Minor: First- and second-degree burns that cover less than 10% of the body are considered minor and rarely require hospitalization.
- Moderate: Second-degree burns that cover about 10% of the body are classified as moderate. Burns on the hands, feet, face or genitals can range from moderate to severe.
- Severe: Third-degree burns that cover more than 1% of the body are considered severe.
Management and Treatment
How are burns managed or treated?
Burn treatment varies depending on the cause and severity. You need to keep all burns clean and apply proper bandages/dressing depending on the severity of the wounds. Treating the person’s pain is key: inadequate control can interfere with wound care.
Continue to check wounds for signs of infection and other long term issues, such as scarring and tightening of the skin over joints and muscles, which makes them difficult to move.
Treatments by burn type include:
- First-degree burns: Run cool water over the burn. Don’t apply ice. For sunburns, apply aloe vera gel. For thermal burns, apply antibiotic cream and cover lightly with gauze. You can also take over-the-counter pain medication.
- Second-degree burns: Treatment for second- and first-degree burns is similar. Your healthcare provider may prescribe a stronger antibiotic cream that contains silver, such as silver sulfadiazine, to kill bacteria. Elevating the burned area can reduce pain and swelling.
- Third-degree burns: Third-degree burns can be life-threatening and often require skin grafts. Skin grafts replace damaged tissue with healthy skin from another of the uninjured part of the person’s body. The area where the skin graft is taken from generally heals on its own. If the person does not have enough skin available for a graft at the time of injury, a temporary source of graft can come from a deceased donor or a human-made (artificial) source but these will eventually need to be replace by the person’s own skin. Treatment also includes extra fluids (usually given intravenously, with an IV) to keep blood pressure steady and prevent shock and dehydration.
What are the complications of burns?
Third-degree burns that are deep and affect a large portion of skin are very serious and can be life-threatening. Even first- and second-degree burns can become infected and cause discoloration and scarring. First-degree burns don’t cause scarring.
Potential complications of third-degree burns include:
- Arrhythmia, or heart rhythm disturbances, caused by an electrical burn.
- Disfiguring scars and contractures.
- Edema (excess fluid and swelling in tissues).
- Organ failure.
- Seriously low blood pressure (hypotension) that may lead to shock.
- Severe infection that may lead to amputation or sepsis.
1 Degree Burn Healing
How can I prevent a burn?
Burns have many accidental causes. You can take these steps to reduce the risk of burns:
- Wear sunscreen.
- Set your home’s hot water heater below 120 degrees Fahrenheit.
- Always test the water in a shower or bath before getting in or bathing a child.
- Lock up chemicals, lighters and matches.
- Use the stove’s back burners as much as possible when cooking, turn handles of pots and pans where they won’t be bumped and don’t leave the stove unattended.
- Don’t hold a child when you’re near hot objects, such as the stove.
- Set safeguards around a fireplace and never leave a child unattended.
- Install and regularly test smoke detectors in your home.
- Stock your home with fire extinguishers and know how to use them.
- Cover electrical outlets.
Outlook / Prognosis
What is the prognosis (outlook) for people with burns?
With proper treatment, most first- and second-degree burns heal over two to three weeks. Depending on the burn severity, you may have some scarring, which may fade over time. People recovering from third-degree burns need physical and occupational therapy to maintain joint mobility and improve function. Some people develop post-traumatic stress disorder (PTSD) or depression after a burn event. Thanks to medical advancements, many people who have burns covering even up to 90% of their bodies survive .
1 Degree Burn Picture
When should I call the doctor?
You should call your healthcare provider if you experience:
- Burns on the hands, feet, face or genitalia.
- Burns that don’t improve after two weeks.
- Severe pain.
- Fever, yellow or green discharge, or other signs of infection.
- Signs of PTSD or depression.
What questions should I ask my doctor?
You may want to ask your healthcare provider:
1 Degree Burn Treatment
- What degree is the burn?
- What is the best treatment for this burn?
- What steps can I take to lower the risk of infection?
- What steps can I take to lower the risk of scarring?
- What steps can I take to lower the future risk of accidental burns?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Burns happen accidentally. Children and older adults are at highest risk. All deep burns require treatment to prevent infection and scarring. Third-degree burns are the most serious type and can be life-threatening. However, first- and second-degree burns are more painful. If you or a loved one has a blistering burn, prompt medical attention can aid healing. Talk to your healthcare provider about ways to lower your family’s risk of accidental burns.