ED Coding and Reimbursement Alert

Question: A mother brought in her teen-age son who suffered burns on the eye from sparks off a firecracker. I'm familiar with burn treatment codes for the skin, but are there other criteria I must know before I code for this visit?

New Jersey Subscriber

Answer: Patients who present with eye burns from sparks are usually treated with a topical antibiotic and given a temporary patch. The three key components of the ED visit will most likely be of low and straightforward complexity. Report 99281-99283 (Emergency department visit for the evaluation and management of a patient ...) based on your level of care and documentation. Extreme burns will demand care by an ophthalmologist.

Choosing the right burn diagnosis codes takes more time and proper understanding of how the digits within the codes are characterized. The first three digits of the code indicate the location of the burn on the body, e.g., 940.x, Burn confined to eye and adnexa. The fourth digit indicates the precise nature and specific location of the burn, e.g., 940.4, Other burn of cornea and conjunctival sac.

Note: While eye burn diagnosis codes require only four digits, you should remember that burns on other areas of the body usually demand five. As with eye burns, the three-digit base code indicates what part of the body is burned, e.g., 942.x, Burn of trunk. The fourth digit indicates the severity of the burn, with five gradations that describe the burn from least to most severe, e.g., 942.2x, Burn of trunk; blisters, epidermal loss (second degree). The fifth digit describes the specific location of the burn on the body and is unique to each body area, e.g., 942.22, Burn of trunk; chest wall, excluding breast and nipple. A complete list of fourth digits can be found after each diagnosis code listing in the ICD-9 manual. A shaded box below the base diagnosis code in the ICD-9 manual lists the fifth digits available.

Most burn cases require a second diagnosis code of 948.xx (Burns classified according to extent of body surface involved). The fourth digit details the total percentage of the body burned, and the fifth digit accounts for the percentage of third-degree burns to the body. Review the ICD-9 manual for accurate fourth and fifth digits. But in the case of a direct eye burn, 948.00 ( burn, [any degree] involving less than 10 percent of body surface; less than 10 percent or unspecified) would be appropriate.

Many payers also want an E code specifying the cause of the injury. In your case, you should report E898.1 (Accident caused by other specified fire and flames; other).