General Surgery Coding Alert

5 Guidelines you should alwaysfollow

If you're finding that assigning burn diagnosis codes is a challenge, you're right. Complete diagnosis coding for burns may require three or more ICD9 Codes to describe the injuries accurately. To sort out the confusion, coding experts recommend five easy tips. 1. Identify the Burn Location The first step in burn diagnosis coding is identifying the anatomic location of the burn using the 940-947 ICD-9 codes, says Katie Cianciolo, RHIA, CCS, CCS-P, coding consultant. For example, codes beginning with 941 describe face, head and neck burns. Use the 942 series for burns to the trunk. Codes 943, 944 and 945 describe burns to the arms, hands and legs, respectively.
 
You should assign multiple codes for burns in separate anatomic locations. For instance, if a patient presents with burns on his left arm and right leg as a result of an accident while lighting fireworks, you may report both 943.xx (for the arm burns) and 945.xx (for the leg burns), assigning the fourth and fifth digits as appropriate (see below). 2. List the Highest Burn Degree Only  You should code for only the highest-level burn when you report multiple burns of differing degrees (severity) in the same area, Cianciolo says. You must indicate the severity of a burn by assigning a fourth digit attached to the appropriate 940-947 code(s), as follows:
 0 - Unspecified degree
 1 - Erythema (first-degree)
 2 - Blisters, epidermal loss (second-degree)
 3 - Full-thickness skin loss (third-degree NOS)
 4 - Deep necrosis of underlying tissues (deep third-degree) without mention of loss of a body part
 5 - ... with loss of a body part For example, if a patient has both first- and second-degree burns of the face, you should report only the more severe (second-degree) burns using the location code 941 and a fourth digit of 2. If the same patient also had second- and third-degree burns on the left arm, you would report 943.3x in addition to 941.2x.

3. Use a Fifth Digit to Narrow the Location When reporting the 940-947 ICD-9 codes, you must assign a fifth digit to describe the specific location of the burn within a body area. Unlike the categories for the fourth digit - which are the same regardless of body area - the fifth-digit categories are specific to the affected area. For example, a fifth digit of 1 when applied to 941.xx describes "ear [any part]," whereas a fifth digit of 1 when applied to 942.xx describes "breast."
 
Again, higher-degree burns take precedence over lesser-degree burns in the same general anatomic area. For example, for a [...]