Home Health ICD-9/ICD-10 Alert

Question: Our patient was siphoning gasoline which combusted. He suffered third-degree burns on both arms and second- and third-degree burns on his face. He has skin graft sites on both thighs. How should we code for him?

Answer: Code for the third-degree burns on his face first because third-degree burns on the face are considered worse than third-degree burns on the arms. Don't code for the second-degree burns on the face because burns of the same local site of different degrees are coded to the highest degree.

Rather than coding the fifth digit for face, list the specific fifth digits for the areas of the face affected. Avoid using a "multiple sites" fifth digit when you have documentation regarding the location of the burns.

Once you code for the specific third-degree burns on the face, you should code the third-degree burns on the arms.

Following the Official Coding Guidelines, you should also list a code from the 948.xx (Burns classified according to extent of body surface involved) category to indicate the percentage of body area burned and the percentage of the body that has third-degree burns.

The Guidelines use the "Rule of Nines" to calculate body area, so in your patient's case the face counts as 9 percent, and each arm counts as 9 percent, adding up to 27 percent.