Home Health ICD-9/ICD-10 Alert

Question: Can you help me find an aftercare code for a homebound patient who had second- and third-degree burns on both arms and hands? The burns are substantially healed, but the patient still has some areas that need to be monitored. We will be doing skilled observation and assessment of the wounds. 


Georgia Subscriber


Answer: Report aftercare code V58.43 (Aftercare following surgery for injury and trauma) only if the burns had surgery.

If the burns did not require surgery, such as skin grafts, then you should code only for the burns with no V code for aftercare.

Burns are coded to the location of the burn, with the fifth digit indicating the specific location and the fourth digit indicating the degree burned. If you have both second- and third-degree burns to the same local site, the arms and hands, the official coding guidelines indicate that you should only code the third- degree burns and not the second-degree burns: "Classify burns of the same local site ... but of different degrees to the subcategory identifying the highest degree recorded in the diagnosis."

Because both arms and hands are involved in your patient's situation, you may add a code from the 948.x (Burns classified according to extent of body surface involved) category to indicate the extent of the burn. Each arm counts as 9 percent, according to the rule of nines, so 948.1x (Burns classified according to extent of body surface involved; 10-19 percent of body surface) is the correct code choice.

Select a fifth digit for 948.1x to indicate what portion of the body is third degree. It doesn't matter that the burns are substantially healed; the coding guidelines state that a nonhealing burn is still coded as an acute burn.

Remember, if the burns are your focus of care, placing the burn codes in M0230 means 21 points toward the HHRG. You must also answer "yes" to M0440 (Does this patient have a skin lesion or open wound?).