# Verifying burn coding guidelines



## kjchmiel (Apr 15, 2013)

I am practicing to take the CPC exam and the question was regarding a burn patient.  The question on the practice exam says "the patient was treated for 2nd and 3rd degree burns to the face, 2nd degree burn on his shoulders and forearms, and 3rd degree burns on the fronts of his thighs.  

My practice exam says that the correct answer is 941.30, 943.29, 945.36, 948.42, E897. 

I thought that a coder should always put the highest degree first, but this is putting the 943.29 (2nd degree burns to shoulders and forearms) in front of 945.36 (3rd degree burns to the front of the thighs.  

I have read the guidelines over and over again.  What is correct?


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## mitchellde (Apr 15, 2013)

I am hoping there was more to this question, yes you are correct you always list the 3rd degree burn first, I am having a hard time with the assignment of the 948 code, where did they come up with 20% as 3rd degree since each leg is 18% total, and you only have the front of the thighs and part of the face, without more info it would be difficult to say this is 20%.  also you need the the E codes for place intent and source.


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## kjchmiel (Apr 16, 2013)

*thank you*

Here is the whole question:

Jim was at a bonfire when he tripped and fell into the flames.  Jim sustained multiple burns.  He came to the emergency room via an ambulance and was treated for second and third degree burns on his face, second degree burns on his shoulder and arms, and third degree burns on the fronts of his thighs.  

This is thier rationale:

Burn codes always have no less than 3 codes: A burn code, a total body surface area code (948.XX) and an E code.  You can have more than three codes but never less.  

It goes on to explain the guidelines, so I ommitted that section.  Then, it says that it used 948 to code the TBSA.  (4th digit burned to any degree 9X5=45.  The five areas are face, 2 arms and 2 legs).  5th digit describes only 3rd degree burns, which are head (9), leg1 and leg2(9).  9X3=27.  The E code correctly describes the bonfire incident.


This test was provided to me from a former employee and taught coding for a long time.  She got this practice test from medicalcodingandbilling.com.  I guess I won't be using this test anymore.  It is very confusing.

Thank you for helping me out!

~Kim


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## mitchellde (Apr 16, 2013)

I am not sure who taught the rule of nines but that is incorrect, each leg from hip to toe is 18%, each arm from shoulder to fingertip is 9%, the head is 9% and the perineum is 1%, trunk front 18%, trunk back 18%, and the perineum is 1%, it has to add up to 100% to be correct so 18+18+18+18+9+9+9+1=100.  Also the percent of body surface burned is only required if it is 20% or more involved as 3rd degree (read the coding guidelines).  if it were only the front of the thigh you would not count the entire leg as burned, you must look closely at how much was involved and you do not have that much unless the documentation tells us something more.  so in my opinion the front of the thigh would be a little more than a fourth of the leg so maybe 5%. And to say shoulder and arms is not definitive enough to count the entire arm so maybe half 4% face is not even close to the entire head so maybe 3% so total I get maybe 21% total, so you see where I am going?   Not all burns will have an extent of body surface code only the third degree.  I agree not a good question and even worse answeres and explanation.


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