Coding Corner: Stop Burn Coding From Singeing Your Reimbursement

Keep your cool with these 7 expert steps

With some diagnoses, there is clearly one code series to choose from, but that’s not the case with burns. ICD-9-CM lists codes for both burn location (940-947) and percentage of body burned (948), so you need to know all the details for correct coding.
Even though codes exist for both burn location and percentage of body burned, you don’t necessarily have to report codes from both the 940-947 and 948 series, says Linda Martien, CPC, CPC-H, coding consultant with National Healthcare Review Inc. in Woodland Hills, Calif. Follow these seven expert steps to ensure your burn coding doesn’t end up burning you:
1. Review documentation for all burn-related information. To report the most specific code, you’ll need to know the burn location, the burn degree, and the percentage of body surface burned (this percentage is especially important for third-degree burns).
 
2. Determine burn location. You should use codes 940-947 “to code the burn by body location,” says Lisa Center, CPC, quality coordinator with Freeman Health System in Joplin, Mo. ICD-9-CM divides codes 940-947 by the following locations:

• 940--Burn confined to eye and adnexa
• 941--Burn of face, head, and neck
• 942--Burn of trunk
• 943--Burn of upper limb, except wrist and hand
• 944--Burn of wrist(s) and hand(s)
• 945--Burn of lower limb(s)
• 946--Burns of multiple specified sites
• 947--Burn of internal organs.
Start your coding by choosing the appropriate code based on location. For example, if a patient has a burn on her hand, you know to begin your coding with the 944 series.
3. Select a fourth digit based on degree of burn. If you are reporting 941-946, make sure to select a fourth digit, Center says. Codes 941-946 each list six fourth-digit options to indicate the degree of the patient’s burn:

• 0--Unspecified degree
• 1--Erythema (first degree)
• 2--Blisters, epidermal loss (second)
• 3--Full-thickness skin loss (third degree NOS)
• 4--Deep necrosis of underlying tissues (deep third degree) without mention of loss of a body part
• 5--Deep necrosis of underlying tissues (deep third degree) with loss of a body part.
Exception: Codes 940 and 947 are different: 940 (Burn confined to eye and adnexa) lists fourth digits to indicate both precise location and type of burn (regular, chemical or unspecified); 947 (Burn of internal organs) lists fourth digits to specify precise location.
Examples: For a patient with an acid chemical burn of the cornea and conjunctival sac, you would report 940.3. You only need the fourth digit to report the appropriate code. Likewise, for a patient with a burn in his esophagus, you would report 947.2. No fifth digit is necessary.
4. Select a fifth digit based on precise location. Codes 941-945 also require a fifth digit to [...]

- Published on 2006-03-23