Home Health ICD-9/ICD-10 Alert

Question: Our patient has two burns: a second-degree burn on her right wrist and a first-degree burn on the back of her right hand. How many diagnosis codes do I need to report for these burns?

Answer: You'll need to report at least two codes to fully describe your patient's burns, says Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman--Holman & Associates and CoDR -- Coding Done Right in Denton, Texas. It's true that when a patient has multiple burns of the same local site, you need only list a code for the burn with the highest degree. But your patient's burns involve two different local sites -- the wrist and back of hand.

The code for the burn on the wrist is 944.27 (Burn of wrist[s] and hand[s]; blisters, epidermal loss [second degree]; wrist) and the code for the burn on the back of the hand is 944.16 (...erythema [first degree]; back of hand).

Go further: You may also want to include a code from the 948.xx set (Burns classified according to extent of body surface involved) to represent the total body surface area (TBSA) of your patient's burn. In the scenario you present, your patient's burns impact less than 10 percent of her body surface because they impact only sections of one arm. Each arm makes up 9 percent of a patient's total body surface, according to the "Rule of Nines" upon which the 948.xx codes are based.

When assigning a code from the 948.xx category, the fourth digit indicates the percentage of total body surface involved in a burn of any degree. The fifth digit identifies the percentage of the patient's body surface involved in a third degree burn. You'll assign the fifth digit "0" when less than 10 percent or no body surface is impacted by a third degree burn.

So, in your patient's case, with burns on less than 10 percent of her TBSA and no mention of third-degree burns, you would report 948.00 (Burn [any degree] involving less than 10 percent of body surface; less than 10 percent or unspecified).

Tip: Including 948 is especially important when you are coding for patients with third-degree burns.