ED Coding and Reimbursement Alert

Don't forget to include a code from the 948 series, too

When a patient reports to the ED for burn treatment, the heat is on the coder to choose the proper ICD-9 codes to represent the encounter.

Burn diagnosis coding involves multiple fourth- and fifth-digit codes -- and if the coder does not submit spot-on ICD-9 codes, the insurer could deny the claim due to lack of medical necessity.

Don't fret, though. Follow these steps, and your burn diagnosis coding will be spot-on each and every time.
 
First, Select Burn Location Code
 
Step 1 in burn diagnosis coding is selecting a code from the 940-947 ICD-9 set, says Debra Williams, CPC, coding supervisor at Horizon Billing Specialists in Grand Rapids, Mich. This code represents -the location of the burn with specification to exact body areas,- she says.

Codes in the 940-947 set always extend to at least the fourth digit, which represents burn severity, says Kevin Arnold, CPC, practice manager of Norwalk (Conn.) Hospital's ED Emergency Physician Group. Several codes in the set require you to extend coding to the fifth digit, which further specifies the burn's anatomic location.

Example: A patient with first-degree burns on his left knee reports for treatment. On the claim, you would report 945.15 (Burn of lower limb[s]; erythema [first degree]; knee) to represent the burn.

Exception: If the op notes do not specify the burn site, leave the 940-947 codes off the claim. Instead, choose a diagnosis code from the 949.x group (Burn, unspecified).

Second, Check for Multiple Burn Sites
 
Next, you should make sure that you have coded for every burn on the patient's body; if someone has multiple burns, you should include an ICD-9 code for each injury, Williams says.

For example, a patient reports with a second-degree burn on her forearm and a first-degree burn on her chest wall. On the claim, you would report 943.21 (Burn of upper limb, except wrist and hand; blisters, epidermal loss [second degree]; forearm) and 942.12 (Burn of trunk; erythema [first degree]; chest wall, excluding breast and nipple), Arnold says. With multiple burn claims, always report the most severe burn first.

When the patient has burns of different severity in the same anatomic location, -the burn of the highest degree takes precedence, and the lower-degree burn would not be reported,- Arnold says. For example, if the patient has a first-degree burn to her upper arm with a portion of second-degree burn, report 943.23 (Burn of upper limb, except wrist and hand; blisters, epidermal loss [second degree]; upper arm) for the encounter, he says.
 
Third, Remember -Rule of Nines- for 948 Coding

Once you-ve chosen diagnosis codes for the location of the burn (or burns), you-re ready to select a code from the 948 diagnosis code group. Arnold says to include a 948 code on every burn treatment claim, and to always extend this code to the fifth digit. The fourth digit of the 948 code signifies the total body surface area; the fifth digit represents the amount of third-degree burns on the patient, Arnold says.

When selecting the fourth digit, you-ll need to use the -Rule of Nines- to arrive at the proper number, Williams says. The Rule of Nines divides the areas of the body into the following percentage groups:

- The head and neck, the right arm, and the left arm each equal 9 percent.

- The 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).

- The genitalia equal 1 percent.
 
Consider this example: A patient presents with third-degree burns to her right hand and a large portion of her trunk, but no loss of body part. On the claim, you would report these codes:

- 942.30 (Burn of trunk; full-thickness skin loss [third-degree NOS]; trunk, unspecified site) for the trunk burn.

- 944.30 (Burn of wrist[s] and hand[s]; full-thickness skin loss [third-degree NOS]; hand, unspecified site) for the hand burn.

- 948.11 (Burns classified according to extent of body surface involved; 10-19 percent of body surface; 10-19%) to represent the size/severity of the burn.