Part B Insider (Multispecialty) Coding Alert

Published on Fri Aug 21, 2009 PDF

Follow the 'Rule of Nines' to identify and code the patient's burns appropriately, based on location.

Question: When I am coding the diagnoses for burn victims, do I need to include a code from the 948.xx set on every claim?

Answer: Yes, once you locate code(s) to represent the patient's burn(s), find the appropriate code from 948.xx (Burns classified according to event of body surface involved) as a secondary diagnosis.

The 948.xx codes can also serve as primary diagnoses when the site of the burn is unspecified, according to ICD-9 2009.

Reason: This code helps paint a better picture of the patient's injuries: the fourth digit in the 948.xx code represents the total body surface area (TBSA) burned, and the last digit indicates how much of the TBSA suffered third-degree burns.

You'll employ the "Rule of Nines" to select the fourth and fifth digits. The Rule matches percentages and body areas as follows:

• 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 equal 1 percent.

Example: Let's say a patient has a severely burned right leg: he has multiple second-degree burns on his front right leg and additional thirddegree burns to his back right leg, but no loss of body part. In this instance, you would list the following in this order:

• 945.39 (Burn of lower limb[s]; full-thickness skin loss [third-degree NOS]; multiple sites of lower limb[s]) for the third-degree burn

• 945.29 (... blisters, epidermal loss [second degree]; multiple sites of lower limb[s]) for the second-degree burn

• 948.10 (... 10-19 percent of body surface; less than 10 percent or unspecified) to represent TBSA burned.