ED Coding and Reimbursement Alert

Don't forget to include a code from the 948 series, too When a patient reports to the ED for burn treatment, the heat is on the coder to choose the proper ICD-9 codes to represent the encounter.

Burn diagnosis coding involves multiple fourth- and fifth-digit codes -- and if the coder does not submit spot-on ICD-9 codes, the insurer could deny the claim due to lack of medical necessity.

Don't fret, though. Follow these steps, and your burn diagnosis coding will be spot-on each and every time.
 
First, Select Burn Location Code
 
Step 1 in burn diagnosis coding is selecting a code from the 940-947 ICD-9 set, says Debra Williams, CPC, coding supervisor at Horizon Billing Specialists in Grand Rapids, Mich. This code represents -the location of the burn with specification to exact body areas,- she says.

Codes in the 940-947 set always extend to at least the fourth digit, which represents burn severity, says Kevin Arnold, CPC, practice manager of Norwalk (Conn.) Hospital's ED Emergency Physician Group. Several codes in the set require you to extend coding to the fifth digit, which further specifies the burn's anatomic location.

Example: A patient with first-degree burns on his left knee reports for treatment. On the claim, you would report 945.15 (Burn of lower limb[s]; erythema [first degree]; knee) to represent the burn.

Exception: If the op notes do not specify the burn site, leave the 940-947 codes off the claim. Instead, choose a diagnosis code from the 949.x group (Burn, unspecified).

Second, Check for Multiple Burn Sites
 
Next, you should make sure that you have coded for every burn on the patient's body; if someone has multiple burns, you should include an ICD-9 code for each injury, Williams says.

For example, a patient reports with a second-degree burn on her forearm and a first-degree burn on her chest wall. On the claim, you would report 943.21 (Burn of upper limb, except wrist and hand; blisters, epidermal loss [second degree]; forearm) and 942.12 (Burn of trunk; erythema [first degree]; chest wall, excluding breast and nipple), Arnold says. With multiple burn claims, always report the most severe burn first.

When the patient has burns of different severity in the same anatomic location, -the burn of the highest degree takes precedence, and the lower-degree burn would not be reported,- Arnold says. For example, if the patient has a first-degree burn to her upper arm with a portion of second-degree burn, report 943.23 (Burn of upper limb, except wrist and hand; blisters, epidermal loss [second degree]; upper arm) for the encounter, he says.
 
Third, Remember -Rule of Nines- for 948 Coding

Once you-ve chosen diagnosis codes for the location of the burn (or burns), you-re ready to select a code from the 948 diagnosis code group. Arnold says [...]