General Surgery Coding Alert

Make sure you know the questions to ask to choose the proper code

With some diagnoses, there is clearly one code series to choose from--but that's not the case with burns.

ICD-9-CM lists two distinct sets of diagnosis codes for burns, and in most cases you-ll have to select a code from each set to describe the patient's condition properly. 1. Determine the Burn Location When assigning burn diagnosis codes, you-ll need to know the burn location, the burn degree and the percentage of body surface burned.

First, you should use codes 941-946 -to code the burn by body location,- says Lisa Center, CPC, quality coordinator with Freeman Health System in Joplin, Mo.

ICD-9-CM divides codes 941-946 by the following locations:

- 941--Burn of face, head, and neck
- 942--Burn of trunk
- 943--Burn of upper limb, except wrist and hand
- 944--Burn of wrist(s) and hand(s)
- 945--Burn of lower limb(s)
- 946--Burns of multiple specified sites.
 
For example, if a patient has a burn on her hand, you know to begin your coding with the 944 series. 2. Select a 4th Digit by Degree When reporting a diagnosis from the 941-946 series, you must select a fourth digit, Center says. Codes 941-946 each list six fourth-digit options to indicate the degree of the patient's burn:

- 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 third degree) without mention of loss of a body part
- 5--... with loss of a body part.

Important: You should code for only the highest-level burn when you report multiple burns of differing degrees (severity) in the same area.

Example: The patient has both first- and second-degree burns of the face. In this case, you should report only the more severe (second-degree) burns using the location code 941 and a fourth digit of 2.

If the same patient also had second- and third-degree burns on the left arm, you would report 943.3x in addition to 941.2x. 3. Choose 5th Digit by Precise Location For ICD-9 codes 941-945, you must also assign a fifth digit to indicate the precise location of the patient's burn.

Example: The patient has a second-degree burn on his ankle. You would report 945.23 (Burn of lower limb[s]; blisters, epidermal loss [second degree]; ankle).

Note: The fifth-digit categories are specific to the affected area. For example, a fifth digit of 1 when applied to 941.xx describes -ear [any part],- whereas a fifth digit of 1 when applied to 942.xx describes -breast.-

Once again, higher-degree burns take precedence over lesser-degree burns in the same general anatomic area.

Example: For a third-degree burn on the chest and a first-degree burn on the stomach, report only 942.32 because both burns are on the trunk. But you [...]