How To Use CPT Code 16036

CPT code 16036 describes the procedure of escharotomy, specifically each additional incision made by a healthcare provider after the initial incision. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 16036?

CPT 16036 is a code used to describe each additional incision made by a healthcare provider during an escharotomy procedure. An escharotomy is a surgical incision into the eschar, which is a piece of dead tissue or scab that forms on the surface of the skin. This procedure is typically performed for severe burns to release pressure and improve blood supply to the underlying tissues.

2. Official Description

The official description of CPT code 16036 is: ‘Escharotomy each additional incision (List separately in addition to code for primary procedure).’ This code should be used in conjunction with the primary procedure code, 16035, for the initial incision.

3. Procedure

During an escharotomy procedure, the healthcare provider makes an incision through the eschar to the level of the deep fascia, which is the connective tissue that surrounds deeper structures such as muscles, bones, nerves, and blood vessels. This incision is made to expose the fatty tissue beneath the eschar, cutting only through the burned tissue. The provider must be careful not to disturb major nerves during the incision. The underlying pressure widens the incision significantly, allowing for improved vascular supply and loosening of constriction. Hemostasis, or stoppage of bleeding, is ensured at the site.

4. Qualifying circumstances

CPT 16036 is used when additional incisions are made during an escharotomy procedure. This procedure is typically performed for severe burns that result in the formation of an eschar. It is important to note that CPT 16036 should only be reported in conjunction with the primary procedure code, 16035, for the initial incision.

5. When to use CPT code 16036

CPT code 16036 should be used when a healthcare provider makes additional incisions during an escharotomy procedure. It is important to report this code in addition to the primary procedure code, 16035, for the initial incision. This code should not be reported without an appropriate primary code.

6. Documentation requirements

To support a claim for CPT 16036, the healthcare provider must document the following information:

• Indication for the escharotomy procedure
• Date of the procedure
• Number of additional incisions made
• Location of the incisions
• Extent of the incisions
• Any complications or adverse events
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 16036, it is important to ensure that the primary procedure code, 16035, is also reported. This code should only be used for each additional incision made during the escharotomy procedure. Payers may not reimburse for CPT 16036 if it is reported without an appropriate primary code. It is important to follow the specific guidelines provided by the payer and ensure accurate documentation to support the claim.

8. Historical information

CPT 16036 was added to the Current Procedural Terminology system on January 1, 2001. It has not undergone any updates since its addition. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Similar codes to CPT 16036

There are several similar codes to CPT 16036 that are used for different procedures. These include:

• CPT 16035: This code is used for the initial incision during an escharotomy procedure.
• CPT 16020-16030: These codes are used for debridement and curettement of burn wounds.

9. Examples

1. A healthcare provider performs an escharotomy on a patient with severe burns. During the procedure, they make three additional incisions to release pressure and improve blood supply.
2. Following an initial incision for an escharotomy, a healthcare provider determines that two additional incisions are necessary to adequately relieve pressure and improve tissue viability.
3. During an escharotomy procedure, a healthcare provider makes four additional incisions to ensure proper vascular supply and prevent tissue necrosis.
4. After performing the initial incision for an escharotomy, a healthcare provider determines that one additional incision is needed to fully release pressure and improve blood flow.
5. A patient with severe burns undergoes an escharotomy procedure. The healthcare provider makes two additional incisions to relieve pressure and promote tissue healing.
6. Following the initial incision for an escharotomy, a healthcare provider determines that three additional incisions are necessary to prevent tissue necrosis and improve tissue viability.
7. During an escharotomy procedure, a healthcare provider makes five additional incisions to ensure proper blood supply and prevent tissue damage.
8. After performing the initial incision for an escharotomy, a healthcare provider determines that no additional incisions are necessary to relieve pressure and improve tissue perfusion.
9. A patient with severe burns undergoes an escharotomy procedure. The healthcare provider makes three additional incisions to release pressure and promote tissue healing.
10. Following the initial incision for an escharotomy, a healthcare provider determines that four additional incisions are needed to adequately relieve pressure and improve tissue viability.