Part B Insider (Multispecialty) Coding Alert

Hint: Anesthesia coders follow the same tactic as surgical coders.

Coding for burns that affect several anatomic areas can get tricky, but that doesn't mean your claims should go up in smoke. Keep two key points in mind, and you'll be on your way to correctly reporting your anesthesiologist's service.

Watch the Diagnosis

The surgeon will assess burn severity as first, second, or third degree. First-degree burns usually only redden the skin, while second-degree (partial thickness) burns affect both the outer and underlying skin layers, causing pain, redness, swelling, and extensive blistering. Third-degree (full thickness) burns extend into deeper tissues and cause white or blackened, charred skin that may be numb because the burn trauma has destroyed the nerve endings.

An anesthesiologist will be called in to assist during treatment for third degree burns, or possibly second degree. You'll assign an ICD-9 code from the range 940.x-947.x (Burn ...), which accounts for the burn's severity and body site.

"The diagnosis code is crucial to show medical necessity for treatment, especially for third-degree burns," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program in Seattle.

Follow the Nines

When it's time to choose the appropriate anesthesia code, you first calculate the percentage of involved skin. "Use the 'Rule of Nines,'" says Pamela Biffle, CPC, CPC-P, CPC-I, CCS-P, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Austin, Texas. The rule divides the body into certain areas to help you code burns by percentages. The calculations for children are a bit different, but the rule for calculating burns on adults states:

• 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 equals 1 percent.
• Select the treatment code based on that percentage, says Biffle. However, you must also know how to convert any documented areas into percentages.

Scenario: A patient has third degree burns to 65 percent of his total body area. The operative report states that the surgeon debrided 1400 square cm of the chest and shoulders, but gives no other details. How do you calculate the correct percentage of burns to code?

"Remember that the Rule of Nines applies to anesthesia coders just as it does surgical coders," says Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fl. "Although 65 percent of the patient's body is burned, the surgeon is currently treating the chest and shoulders."

The treated area represents upper chest (approximately 9 percent) and shoulders (approximately 3 percent each), for an approximate total of 15 percent. The applicable anesthesia codes are based on the total body surface area (TBSA) treated:

• 01952 -- Anesthesia for second- and third-degree burn excision or debridement with or without skin grafting, any site, for total body surface area (TBSA) treated during anesthesia and surgery; between 4% and 9% of total body surface area
• +01953 -- ... each additional 9% total body surface area or part thereof (List separately in addition to code for primary procedure).

Code it: Report 01952 for the first 9 percent of the treated area, then 01953 to represent the remaining 6 percent.

"If the entire burned area was being treated, the coder would report 01952 once and 01953 as many times as necessary to reach the total percentage affected," Dennis says.

Following this logic, you would code the scenario of 65 percent TBSA affected with 01952 for the first 9 percent, then 01953 x 7 for the remaining 56 percent. "The code descriptor reads 'or any part thereof,'" Dennis explains. "If you report one unit of 01952 and 6 units of 01953, it only adds up to 63 percent. Reporting 7 units of 01953 covers the entire area."