Medicare Compliance & Reimbursement

Fourth, fifth digits are vital to these ICD-9 codes To accurately code diagnoses for patients with burn injuries, coders must know whether the patient had any third-degree burns. They also need to know when to combine multiple burns into one ICD-9 code and when to submit a separate code for each burn. Check out this expert advice on burn diagnosis coding, and follow these four steps each time you are coding for a burn victim. 1. Select Burn Location: The first diagnosis code you'll select for burn victims represents the location of the burn (or burns) and its severity. You'll find these codes in the 940-947 ICD-9 set, says Debra Williams, CPC, coding supervisor at Horizon Billing Specialists in Grand Rapids, MI. All the codes in the 940-947 set require at least a fourth digit, and some require five, says Linda Martien, CPC, CPC-H, coding specialist at National Healing Inc. in Boca Raton, FL. These codes "break down the classification first by anatomic site and then by degree of burn," she says. Example: The physician's notes indicate that a patient suffered a first-degree burn to his chest wall. Based on this description, 942.12 (Burn of trunk; erythema [first degree]; chest wall, excluding breast and nipple) is the correct diagnosis. Exception: The codes that extend only to the fourth digit (940.X, 946.X, 947.X) do not describe both burn severity and burn location. In these cases, just code based on what ICD-9 requires for the burn. For instance, take a look at 940.3 (Burn confined to eye and adnexa; acid chemical burn of cornea and conjunctival sac), which does not require a fifth digit. This diagnosis is first defined as a burn confined to eye and adnexa (940.x), and the "3" further defines the injury, describing an acid chemical burn of the eye's cornea and conjunctival area. 2. Check That You've Coded Each Burn: Patients who present for burn care will often have more than one burn. Check out this quick Q&A, which describes how to code for several multiple-burn scenarios: Question: What if the patient has burns in different anatomical locations? Answer: Code separately for each burn. So if the patient has first-degree neck burns and second-degree shoulder burns, you would report the following: • 943.25 (Burn of upper limb, except wrist and hand; blisters, epidermal loss [second degree]; shoulder) for the second-degree burn • 941.18 (Burn of face, head, and neck; erythema [first degree]; neck) for the first-degree burn. On all multiple-burn claims, you should code the burn of the highest severity first, Williams says. Question: What if the burns are of the same severity and in the same anatomic location? Answer: You should be able to represent them with [...]