ED Coding and Reimbursement Alert

Question: I have been coding for a few months, but I still get stumped on burn diagnosis coding. Could you explain how to apply the 948.xx ICD-9 codes on claims? I know how to code for the burn location, but I am lost in the 948.xx section.

Louisiana Subscriber

Answer: The first step in burn diagnosis coding is choosing a diagnosis code for the location of the burn (or burns) from the 940-947 code sets. Since you-ve already got that down, you need to focus on selecting a code from the 948 (Burns classified according to extent of body surface involved ...) diagnosis code group to represent the total body surface area (TBSA) of the burn and the amount of third-degree burns on the patient.

Remember to include a 940-947 code and a 948 code on every burn care claim. Both codes are vital to your reimbursement. When you choose a 948 code, you must extend the code to the fifth digit. The fourth digit signifies the TBSA, and the fifth digit represents the percentage of third-degree burns the patient has.

Remember the -Rule of Nines-: Coders should use the -Rule of Nines- to find the correct fourth digit of the 948 code. The Rule of Nines classifies the areas of the body in the following manner:

• Head and neck, the right arm, and the left arm each equal 9 percent TBSA.
• Back trunk, front trunk, left leg, and right leg each equal 18 percent (the front and back trunk are divided into upper and lower segments, and each leg is divided into back and front segments, each equaling 9 percent).
• Genitalia equals 1 percent.

Suppose a patient has burns encompassing his head and right arm, with no mention of third-degree burns. You would add the head and arm percentages (9 + 9) and arrive at 18 percent TBSA.

On the claim, you would report 948.10 (... 10-19 percent of body surface; less than 10 percent or unspecified) in addition to the diagnosis code(s) from the 940-947 family.