Home Health ICD-9/ICD-10 Alert

Question: When I am coding the diagnoses for burn victims, do I need to include a code from the 948.xx set for every patient?

Answer: Yes, once you locate code(s) to represent the patient's burn(s), find the appropriate code from 948.xx (Burns classified according to exent of body surface involved) as a secondary diagnosis. The coding guidelines state that it is advisable to use a code from category 948 when there is mention of a thirddegree burn involving 20 percent or more of the patient's body surface.

The 948 codes provide additional information when a patient has multiple second-degree burns mixed in with third-degree burns because the guideline asks that multiple burns of the same site be coded to the highest degree.

Problem: The use of the 948 code would account for the patient's second degree burns that are not otherwise coded.

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:Your patient has a severely burned right leg. He has multiple second-degree burns on the front of his thigh and calf of his right leg and additional thirddegree burns to the back of his thigh and calf of his right leg, but no loss of body part. In this instance, you would list the following in this order:

• 945.36 (Burn of lower limb[s]; full-thickness skin loss [third-degree NOS]; thigh (any part)) for the third-degree burn of the thigh;

• 945.34 (Burn of lower limb[s]; full-thickness skin loss [third-degree NOS];lower leg) for the thirddegree burn of the calf; and

• 948.10 (... 10-19 percent of body surface; less than 10 percent or unspecified 3rd degree) to represent TBSA burned.