Precise Diagnosis Coding, Careful CPT Selection Are Vital When Billing For Burn Treatments
Published on Fri Jun 01, 2001
To establish medical necessity for burn treatments, surgeons must supply the correct diagnoses codes. This can be confusing because codes from two different ICD-9 series must be used in tandem. In addition, both the site of the treatment and the size of the affected area must be documented clearly.
Select ICD-9 by Location and Severity
Burn diagnosis codes fall within ICD-9 range 940-949. Selecting the correct diagnoses for burns can be difficult because:
The physician may not have clearly or accurately described the location or extent of the burn
More than one ICD-9 code may be necessary to indicate the location, extent and severity of the burn(s)
If the same area has multiple burns of differing degrees, only the highest-level burn should be noted.
The ICD-9 manual includes two types of codes that, when used correctly, provide information on the location, extent and severity of the burn(s). These diagnoses justify the treatments provided, explains Marcella Bucknam, CPC, billing and compliance manager with the department of surgery at the University of Nebraska Medical Center in Omaha. If the patients chart (and the ICD-9 codes) indicates only second-degree burns, for example, the carrier may want to know why an escharotomy was performed.
The first set of codes (941-945) indicates the location and severity of the burn(s). The initial three digits describe the general location. For example, codes beginning with 941 describe burns to the face, head and neck. The 942 series is used for burns to the trunk. Codes 943, 944 and 945 describe burns to the arms, hands and legs, respectively.
The fourth digit in this code series describes the severity of the burn, from least to most severe, 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.
The fifth digit describes 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 instance, the following fifth-digit classifications apply only to the trunk (942):
0 unspecified site
1 breast
2 chest wall
3 abdominal wall
4 back (any part)
5 genitalia
9 other and multiple sites of trunk.
Higher-degree burns in the same area take precedence over lesser burns, Bucknam notes. For example, if the patient has a third-degree burn on the chest and a second-degree burn on the stomach, only 942.32 is coded because both burns are located on the trunk. An additional second-degree burn on the upper arm, however, should be [...]
