Coding Consult

October 21, 2005

Answers to your questions about...uncomplicated burns; multiple diagnoses

Uncomplicated burns

Q. A patient came in with first- and second-degree burns on her hand. I cleaned and dressed the burn but didn't debride it. Should I bill 16000 and 16020?

Remember to append modifier –59 (distinct procedural service) to 16000. The modifier indicates that you treated the first-degree burn on a separate site from the dressing and/or debridement. Without modifier –59, insurers may bundle 16000 into 16020.

New or established patients

Q. While on call at the ED, I treated a patient for migraines. A month later she came to see me at my office for another condition. Should I code this visit as new or established?

A. You should report the appropriate established patient E&M code (99211-99215). CPT defines a new patient as "one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past three years."

Remember that a patient's status doesn't affect hospital care coding. You report initial hospital care with 99221-99223 (initial hospital care, per day, for the evaluation and management of a patient . . .) and subsequent hospital care as 99231-99233 (subsequent hospital care, per day, for the evaluation and management of a patient . . .), regardless of whether the patient is new or established.

Multiple diagnoses

Q. How should I code a visit with multiple diagnoses?

A. Prioritize them in descending order of importance, starting with the one that receives the most attention at the visit. For instance, a patient presents with an upper respiratory infection and chest pain from coughing. You send the patient to a radiologist for a chest X-ray. The radiologist interprets the results as normal. In this case, you should report the symptom, chest pain (786.50, chest pain, unspecified), which prompted the chest X-ray, in the first position (diagnosis 1) on the claim form.

List the initial reason for the visit, the URI (465.9, acute upper respiratory infections of multiple or unspecified sites; unspecified site), in the second position. Reversing the order and reporting the URI in the first position may trigger a denial. Code 465.9 may not be accepted by all payers as meeting the medical necessity for a chest X-ray, but 786.50 clearly tells the payer why you ordered the test.

This information adapted from material provided by the Coding Institute. For a free sample issue or information on how to subscribe to any of 29 specialty-specific coding newsletters, please contact the Coding Institute, 2272 Airport Road South, Naples FL 34112; phone 800-508-2582; fax 800-508-2592 or visit http://www.codinginstitute.com.