ED Coding and Reimbursement Alert

948.xx series challenges coders to compile TBSA

Before you can select the appropriate burn treatment procedure code from the 16000 series, you must choose the proper diagnosis code from the 948.xx set to estimate the amount of body surface burned and the percentage of third-degree burns.

How? To use the 948.xx set properly, you-ll have to know the -Rule of Nines,- which is a way of dividing total body surface area (TBSA) so physicians can report what percentage of a patient's body was burned, says M. Tray Dunaway, MD, FACS, CSP, CHCO, of Healthcare Value Inc. in Camden, S.C.

According to CPT, the Rule of Nines breaks down like this for adults:

- Head and neck, right arm, and left arm each equal 9 percent of TBSA.

- Back trunk, front trunk, left leg, and right leg each equal 18 percent of TBSA (the front and back trunk can be divided into upper and lower segments, and each leg can be divided into front and back, each equaling 9 percent).

- The genitalia equals 1 percent of TBSA.

-I also use the approximation of 1 percent [of TBSA] for a handprint,- Dunaway says.

Many Patients Burned in More Than 1 Area

Consider this example: A patient who opened a hot automotive radiator cap suffered second-degree burns on his right hand and forearm up past the elbow. He also suffered second-degree burns to both sides of his face.

In the above scenario, the arm burns constitute 9 percent TBSA, and the face burns count for another 9 percent, meaning the patient suffered burns on 18 percent of TBSA. There is no mention of third-degree burns on the patient. The correct diagnosis code for the TBSA in this scenario is 948.10 (Burns classified according to extent of body surface involved; burn involving 10-19 percent of body surface; third degree less than 10 percent or unspecified).

Also: You need to remember to code for the location(s) of the burn(s) as well with ICD-9 codes from the 941-947 series. In this example, the burn location codes would be:

- 944.28 (Burns of wrist[s] and hand[s]; blisters, epidermal loss [second degree], multiple sites of wrist[s] and hand[s]) for the hand burn.

- 943.21 (Burn of upper limb, except wrist and hand; blisters, epidermal loss [second degree], forearm) for the arm burn.

- 941.29 (Burn of face, head, and neck; blisters, epidermal loss [second degree], multiple sites [except with eye] of face, head, and neck) for the face burn.

Kids- Nines Different From Adults-
 
Remember that the above explanation of the -Rule of Nines- applies to adult burn patients only. -For pediatrics, the rule is a bit different,- Dunaway says.

To account for their -big heads and little bodies,- the -Rule of Nines- breaks down like this for children,  Dunaway says:

- Head--18 percent of TBSA
- Chest and abdomen--18 percent of TBSA
- Each arm--9 percent of TBSA
- Each leg--14 percent of TBSA.

Tip: Many CPT manuals have a visual chart illustrating the Rule of Nines; look for it near the 16000 series of codes, under the -Calculation of Total Body Surface Area (TBSA) Burn- subheading.