Part B Insider (Multispecialty) Coding Alert

Published on Wed Jul 26, 2006 PDF

Before you can select the appropriate burn treatment procedure code from the 16000 series, you must choose the proper diagnosis code from the 948.xx set to estimate the amount of body surface burned and the percentage of third-degree burns. Here's how:

The -Rule of Nines- is a method of dividing total body surface area (TBSA) so physicians can report what percentage of a patient's body was burned, explains M. Tray Dunaway, MD, FACS, CSP, CHCO, of Healthcare Value Inc. in Camden, SC. According to CPT, the rule breaks down like this for adults:

- Head and neck, right arm, and left arm each equal 9 percent of TBSA.

- Back trunk, front trunk, left leg and right leg each equal 18 percent of  TBSA (front and back trunk can be divided into upper and lower seg - ments and each leg into front and back, each equaling 9 percent).

- The genitalia equals 1 percent of TBSA. Note: -I also use the approxi- mation of 1 percent [of TBSA] for a handprint,- Dunaway says.

Example: A patient who opened a hot automotive radiator cap suffered second-degree burns on his right hand and forearm up past the elbow. He also suffered second-degree burns to both sides of his face. In this scenario, the arm burns constitute 9 percent TBSA and the face burns count for another 9 percent, meaning the patient suffered burns on 18 percent of TBSA. There is no mention of third-degree burns on the patient. The correct diagnosis code for the TBSA in this scenario is 948.10 (Burns classified according to extent of body surface involved).

Remember: Code for the location(s) of the burn(s) as well with ICD-9 codes from the 941-947 series. In the above example, the burn location codes would be: 944.28 (Burns of wrist[s] and hand[s]) for the hand burn, 943.21 (Burn of upper limb, except wrist and hand-) for the arm burn, and 941.29 (Burn of face, head, and neck-) for the face burn.