General Surgery Coding Alert

Question: Our general surgeon treats burn victims, and I'm wondering about diagnosis coding in these cases. Do I need to include a code from category 948 on every claim?

Michigan Subscriber

Answer: Yes. Once you locate code(s) to represent the patient's burn(s), find the appropriate code from category 948 (Burns classified according to event of body surface involved) as a secondary diagnosis. The 948.xx codes can also serve as primary diagnoses when the documentation doesn't specify the burn site, according to ICD-9 2010.

Reason: This code helps paint a better picture of the patient's injuries: The fourth digit in the 948.xx code  represents the total body surface area (TBSA) burned, and the last digit indicates how much of the TBSA suffered third-degree burns.

You'll employ the "Rule of Nines" to select the fourth and fifth digits. The Rule matches percentages and body areas as follows:

• 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)
• genitalia equal 1 percent.

Example: Let's say a patient has a severely burned right leg. The patient has multiple second-degree burns on the front of his right leg and additional third-degree burns to the back of his right leg, but no loss of body part. In this instance, you would list the following diagnosis codes in this order:

• 945.39 (Burn of lower limb[s]; full-thickness skin loss [third-degree NOS]; multiple sites of lower limb[s]) to describe the patient's third-degree burn
• 945.29 (... blisters, epidermal loss [second degree]; multiple sites of lower limb[s]) to describe the seconddegree burn
• 948.10 (... 10-19 percent of body surface; less than 10 percent or unspecified) to represent the TBSA burned and the percentage of third-degree burns present.