Karen Posted Thu 07th of November, 2019 11:02:32 AM
What is the proper reporting when a burn patient has had serial debridement's of a burn wound, after graft placement returns to the OR for assessment of the graft and dressing change. I read a article that I can't seem to locate stating that under this circumstance the burn is not being treated rather the assessment of the graft therefore 15852 should be assigned rather than series of codes 160xx. Can you confirm?
SuperCoder Answered Fri 08th of November, 2019 08:39:31 AM
Thanks for your question.
In code 15852 the provider changes the dressing on a wound, unrelated to a burn, in a patient who requires general anesthesia due to the painful nature of the dressing change or in a patient unable to cooperate with a dressing change while awake.
Therefore, as in your scenario using code 15852 may not be appropriate as the code is unrelated to burn and also require patient to undergo general anesthesia.
Do not use code 15852 in the case of burns. Use the appropriate codes from the section 16000 to 16036, Local Treatment Procedures for Burns.
Also, you can Append modifier 58 to a procedure occurring during the postoperative period when the procedure is planned or staged.
Hope this helps.
Karen Posted Fri 08th of November, 2019 10:41:07 AM
So to clarify- Because the skin graft was placed for an associated "burn wound" it nullifies 15852? Is skin grafting considered "Local Treatment" which is defined in super coders clinical responsibility below. Is he treating the burn wound or assessing the viability of the graft; the patient is under anesthesia ?
For treatment of a burn wound, a physician first cleans the wound with an antiseptic solution. Then the physician removes blisters, loose or dead skin, and tissues in order to inhibit the growth of microbes and to aid the healing process. The wound is then dressed appropriately.
SuperCoder Answered Mon 11th of November, 2019 10:11:26 AM
Thanks for your question.
If the patient had serial debridement's of a burn wound, and after graft placement returns within the post-operative global period then no code should be billed since the services will be considered included in the global period.
As per the scenario you shared, the patient didn’t come for local treatment procedures for burn wound, rather the patient is coming in for the assessment for viability of the graft. If the patient is coming for assessment during postoperative global day period, then no code will be billed. Since, the debridement and skin grafting was performed for the burn wound, we cannot use code 15852.
Can you please provide us with the CPT code you billed for debridement's of a burn wound and graft placement?
Karen Posted Wed 27th of November, 2019 14:10:44 PM
The dressing change is inpatient OR under anesthesia.
SuperCoder Answered Thu 28th of November, 2019 08:12:20 AM
Hi As per the tips provided by AMA dressing change procedure for burn wounds performed not under anesthesia setting code range - should be used As per the NCCI edit guidelines code describes a dressing change other than for burns under anesthesia other than local Per your scenario dressing change...
Karen Posted Thu 12th of December, 2019 12:53:37 PM
I have clarified with other reputable sources that 15852 the correct assignment in this scenario as the burn is not what's being treated. Thank you.
SuperCoder Answered Fri 13th of December, 2019 08:33:24 AM
Okay. We wish you with the best reimbursement.