General Surgery Coding Alert

5 Guidelines you should alwaysfollow

If you're finding that assigning burn diagnosis codes is a challenge, you're right. Complete diagnosis coding for burns may require three or more ICD9 Codes to describe the injuries accurately. To sort out the confusion, coding experts recommend five easy tips.

1. Identify the Burn Location

The first step in burn diagnosis coding is identifying the anatomic location of the burn using the 940-947 ICD-9 codes, says Katie Cianciolo, RHIA, CCS, CCS-P, coding consultant. For example, codes beginning with 941 describe face, head and neck burns. Use the 942 series for burns to the trunk. Codes 943, 944 and 945 describe burns to the arms, hands and legs, respectively.
 
You should assign multiple codes for burns in separate anatomic locations. For instance, if a patient presents with burns on his left arm and right leg as a result of an accident while lighting fireworks, you may report both 943.xx (for the arm burns) and 945.xx (for the leg burns), assigning the fourth and fifth digits as appropriate (see below).

2. List the Highest Burn Degree Only

 You should code for only the highest-level burn when you report multiple burns of differing degrees (severity) in the same area, Cianciolo says. You must indicate the severity of a burn by assigning a fourth digit attached to the appropriate 940-947 code(s), as follows:
 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

For example, if a patient has both first- and second-degree burns of the face, 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. Use a Fifth Digit to Narrow the Location

When reporting the 940-947 ICD-9 codes, you must assign a fifth digit to describe the specific location of the burn within a body area. Unlike the categories for the fourth digit - which are the same regardless of body area - 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."
 
Again, higher-degree burns take precedence over lesser-degree burns in the same general anatomic area. For 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 may code an additional second-degree burn on the arm separately (943.23) because the arm is part of a different body area.

4. Assign Category 948 to Describe the Extent

You should use codes from the 948.xx series as a secondary diagnoses with 940-947. These codes require a fourth and fifth digit, which describe the percentage of the body burned and the percentage of the body affected by third-degree burns, respectively, says Marty Herman, MD, FAAP, FACEP, associate professor of pediatrics at UT College of Medicine, Memphis, Tenn.
 
For instance, a patient presents with second- and third- degree burns over 30 percent of his body with the third-degree burns taking up 20 percent. In this instance, you would report 948.32 (30-39 percent of body surface; 20-29 percent third degree). The surgeon's documentation must support the code selection by noting the percentage of body burned, the body parts affected, and burn severity.
 
You may calculate the burned percentage of the body using the location information described by 940-945 and applying the "rule of nines" (see Apply the 'Rule of Nines' With Better Than 99.99% Accuracy, page 75).

5. Call on 'E' Codes for Accidental Burns

If the burn is accidental, you should report an E code for accidents caused by fire and flames (E890-E899), Herman says. E codes may help determine if a third-party payer is liable for treatment costs. For example, if a woman accidentally burns herself with boiling water, you should use E924.0 (Accident caused by hot substance or object, caustic or corrosive material, and steam; hot liquids and vapors, including steam). Be aware, however, that not all payers recognize E codes. Herman points out other important E codes that you should not forget:

 

E921.x - Accident caused by explosion of pressure vessel
 

E922.x - Accident caused by firearm, and air gun missile
 

E923.x - Accident caused by explosive material
 

E924.x - Accident caused by hot substance or object, caustic or corrosive material, and steam
 

E925.x - Accident caused by electric current
 

E926.x - Exposure to radiation.