ED Coding and Reimbursement Alert

Also, carriers like 2 diagnosis codes on all 16000 claims

When a patient reports to the ED for burn treatment, coders must first determine the size of the burn. Then, they can start looking for the right CPT Code.

Why? The burn treatment code set in CPT 2006 includes three burn categories---small,- -medium- and -large---and coding for the wrong-size burn could result in claim denials.

-It [burn size] will be the key issue. Coders need to determine a small, medium or large burn before they can choose the code,- says Todd Thomas, CPC, CCS-P, president of Thomas & Associates in Oklahoma City. Burn Size Is 1 of 4 Decisions You-ll Make on Claims But choosing the burn size is only the beginning; you-ve also got to:

- assign the appropriate ICD-9 codes
- hunt for the proper burn treatment code
- look for additional services the physician may have provided. After you observe these steps, your burn care coding claims should stand up to even the most spurious scrutiny. Read on for inside tips to prevent you from getting singed by your burn care coding. Choose Dx First When Coding Burns On claims with burn treatment codes, you must include at least two diagnosis codes, Thomas says. The first code, which represents the location of the patient's burn, should come from the 940.x-947.x series.
 
For example, if a patient has a first-degree burn on her third, fourth and fifth knuckles, the proper diagnosis code would be 944.13 (Burn of wrist[s] and hand[s]; erythema [first degree], two or more digits, not including thumb).

The second diagnosis code you-ll need comes from the 948.xx series. This code represents the total body surface area (TBSA) and severity of the burn, says M. Tray Dunaway, MD, FACS, CSP, CHCO, of Healthcare Value Inc. in Camden, S.C.

While some of the 947.x codes are only four digits, you must carry all 948.xx codes out to the fifth digit,  Dunaway says. To code the appropriate fourth and fifth digits, you must know:

- Fourth digit--Percent of total body surface area affected by the burn of any degree.
- Fifth digit--Percent of body surface with third-degree burns.
 
Example: If a patient's diagnosis is 948.11 (Burns classified according to extent of body surface involved;  burn involving 10-19 percent of body surface; 10-19 percent of body surface third degree), the fourth digit indicates that 10 to 19 percent of TBSA was burned. The fifth digit indicates that between 10 and 19 percent of the TBSA contained third-degree burns.

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