CCI Updates You Need to Know

In the most recent updated of the Correct Coding Initiative (CCI) there are a number of edits you won’t want to miss if the services to the patient include debridement and treatment on the same burn site.

CCI version 13.1 outlaws reporting a pair of debridement codes with certain burn treatment codes in most situations. However, CCI now bundles 11000 (Debridement of extensive eczematous or infected skin; up to 10 percent of body surface) and 11040 (Debridement; skin, partial thickness) into 16020 (Dressings and/or debridement of partial thickness burns, initial or subsequent; small [less than 5 percent total body surface area]), 16025 (… medium [e.g., whole face or whole extremity, or 5 percent to 10 percent total body surface area]) and 16030 (… large [e.g., more than one extremity, or greater than 10 percent total body surface area]).

These edits were developed to reduce the amount of redundant coding that was happening on debridement of burns medical billing claims. The burn code descriptions include debridement, so you should not report both codes when treatment occurs on the same wound as this type of service can be bundled.

Another key for handling this type of claim is to look for exceptions. All of these burn/debridement edits contain a modifier indicator of “1.” The “1” means you can report both of these codes for the same encounter in certain situations–and with modifier 59 (Distinct procedural service) attached to the component (bundled) code.

In addition, be sure to attach a correct diagnosis code to the debridement to support the need for the separate service. You should link the burn diagnoses only to 16020 in this case. You should link a skin ulcer or open wound code (as appropriate) to 11000 to clarify why the surgeon performed the separate debridement.

Use these tips and make sure you’re maximizing your debridement/burn claims in your medical billing claims.

View all Articles by: Kathryn Etienne, CCS-P