ED Coding and Reimbursement Alert

Accurate codes tell exact location and severity When a patient with a burn shows up in the emergency department, coding can get heated right away - mainly because the first step is so difficult to report.

Burn diagnosis coding, which the physician must perform before reporting any other service, can include multiple five-digit codes. Documentation must reflect severity and burn location, and the patient may have more than one burn area to report. Step 1: Code for the Burn Location Before you do anything else in burn diagnosis coding, you must select a code from the 940-947 ICD-9 group to explain the injury's anatomic location. Codes from this group are always at least four digits. In burn cases, you may need two or more different codes from the 940-947 group for a single patient. 
   
"The first code is for the injured part of the body, the part that's been burned: the foot, the head, the chest, etc.," says Patricia Sylvia, RN, CPC, of Outer Banks Emergency Physicians in Nags Head, N.C. "These ICD-9 codes are for different (anatomic) areas."

"When coding for burns, make sure that you use separate codes for each burn site on the body," says Joan Gilhooly, CPC, CHCC, president of Medical Business Resources LLC, in Deer Park, Ill. This means that multiple diagnosis codes are allowable when you report the condition of one burn patient, so don't be afraid to use more than one code from the 940-947 series if the situation calls for it.
 
Example: A patient presents to the emergency department with burns on her right thigh, right foot, and the right side of her trunk. To describe her injuries, you would report a code from the 942.xx series (Burn of trunk) and a code from the 945.xx series (Burn of lower limb[s]) to account for the entirety of the burn area.

Warning: These diagnosis codes don't include all types of burns, however - so make sure the burn you are reporting is indeed part of the 940-947 code group.

"These codes (940-947) don't include friction burn and sunburn. Those need to be excluded right off the bat" when reporting burns, Gilhooly says.

If your patient has sunburn, choose the proper code from the 692.7x group (Contact dermatitis and other eczema; due to solar radiation). Diagnosis codes for friction burns are chosen from the "Superficial Injury" group (910-919). Step 2: Determine the Appropriate Fourth Digit The 941-947 burn diagnosis codes must extend at least to the fourth digit, which reflects burn severity. When considering the burn's seriousness, use these fourth-digit codes:

0 - Unspecified degree

1 - Erythema (first-degree)

2 - Blisters, epidermal loss (second-degree)

3 - Full-thickness skin loss (third-degree NOS)

4 - Deep necrosis of underlying tissues (deep [...]