Burn coding. A student asked us to review ICD coding for burns. So if you have your coding manuals, I’m going to be turning to the tabular section of ICD 9 starting with code 940.
So at any rate, here’s the Burn category in ICD-9 and you’ll see, just like all of ICD, you get your includes and excludes list. So it excludes friction burns, sunburns… and they forgot one. If you want to write it in… sideburns. Hahaha. I need a live… a bigger live group for that. But in any rate, I do that sometimes because students like hang on to your every word and they write everything down and they go, “Wait a minute.”
Alright so the first thing we need to identify with burns is we’ve got these 3 digit categories. So 940 Burn confined to (23.18). And by the way, the range for the burn category, it’s telling us, it goes from 940 to 949 so let’s just get a lay of the land. What’s the difference between the categories, the 3 digits? 941 is burns of face, head and neck, and 942… I’m going to turn the page.
Laureen: Alright so 942, burn of the trunk. So the difference between the 3… the categories is location, general location. Now this is the point where I’ll ask my students, “Okay what do we need to figure out next? And they’ll say, “Oh is it the chest, the back or the genitalia?” I’m like, “No, that’s 5th digit.” We can’t jump from 3rd digit to 5th digit box. Okay, we need to go down below the box to the 4 digits. So this is good instruction, not just for burn coding but for general ICD coding. Don’t think that things go in order.
ICD 9 CM Burn Coding VIDEO
So what’s the difference between the 4 digits? And what I love about this is that they’re all the same for each of the categories. A 0.0 means unspecified degree. .1 is first degree. 0.2 is second degree. .3 is third degree. .4 is deep 3rd degree and .5 is deep 3rd with a loss of body part. So that’s always the same. The 4th digit for ICD 9 is the depth of the burn, if you will.
So we know location, depth and now we need to know more specifically, the location. So for this burn of the back, if I said it was a 3rd degree burn of the back, we’re going to say, okay 942 of the trunk and then the 3rd degree, it’s going to be .3 and then we come up to the 5th digit box. It’s going to be 4. So 942.34 is going to be the code for that. That’s pretty easy when you just have one burn. Quite often, unfortunately, there’s multiple burns to contend with.
So what do you do when you have more than one burn… like, if I had a burn of the trunk and a burn of the arm, I’m going to be in 2 different categories. I’m going to have 2 codes. But what do you when you have 2 burns in the same category? What if I have a burn of the back and a burn of the breast? They’re in the same category, right? So if the back was a 3rd degree and the breast was a 2nd degree, what the guidelines tell us is that you code the most severe burn first. So it’s going to be 942.3 but the 5th digit will be the 5th digit of 9 other and multiple sites of the trunk. You can tell I’ve been here before.
Okay so what a common newbie mistake is they’ll say, “Oh, ICD 9 CM burn coding guidelines say I code the worse burn.” So they code 942.3 and they use 4 for back when they miss the point that they should have used 9 to indicate it’s multiple burns in that category, the worse one being a 3rd degree. Okay so whenever you’re coding multiple burns in the same category, you’re only going to have one code per category. And if there’s more than one, you’re going to use the multiple 5th digit code. In this case, it 9.
Alright now the other piece of the story is using code 948 because I’m a mom. If my kid got hurt and they got burned then I’m going to be like, “What percent of their body was affected? Is it just their finger? Okay, we can deal with that.” But if it’s like you know, their whole arm or you know, it’s the extent. Not just where and how deep but the extent. So 948 tells that story.
Okay so 948 says burns classified according to extent of body surface involved. Now I did make a little cross-reference, page 77 of CPT has a nice kind of Rule of Nines picture you can take a look at. They’ve got one of the baby. That’s a great thing to do by the way guys is you know, give yourself cross-references. I always pretend like it’s my pre-exam self writing notes to that self who’s going to be taking the exam. So when you’re taking the exam, you’re like, “Thank you Laureen for doing that.”
So at any rate, we go to 4th digit first and we will look at the 4th digit. We’ve got .0 is less than 10%. .1 is 10 to 19%. .2 is 20-29, you get the idea. What this is for, if you circle this and wrote a note, I would have you write Total Body Surface Area (TBSA). So if you have a burn of the back and the burn of the breast just like we were talking about, what is the total you know, percent of the body that’s affected. So that leaves the 5th digit box which is basically the same pattern. 5th digit is 0 is less than 10. 5th digit of 1 is 10 to 19, etc. But this is for 3rd degree burns only. So they want to know the worst burns. This is all burns. 4th digit is for all burns, 5th digit is 3rd degree only. So the 5th digit number will always be the same or less than the 4th digit because it’s a subset.
So the Rule of Nines says that the head is worth 9% an each arm is worth 9%. Each leg is worth 18%. The back is 18%, the front is 18%. So in our previous example, we said the back was a 3rd degree burn and let’s just say that’s 18%. And then we said the breast, 2nd degree and let’s just call that, I don’t know 5% depending on how endowed you are. Okay so what you want to do is add them together to get the Total Body Surface Area so 18 plus 5 is 23, right? And then of these two burns, which one is 3rd degree only? The 18%, right? We don’t carry over the 15% or the 5% because that’s 2nd degree only. So for the 5th digit, we’re going to be focused on the 18%. 4th digit, we’re going to be focused on the 23%. So here’s a neat trick. 948, whatever the first number is, .21 because 20-29%, right? It’s always going to be a 2. That first number is always going to match. And then for the 18%, 10-19 is going to be a 1, 948.21. Isn’t that a cool trick?
Alicia: I did not know that trick. I am so excited to learn that. That’s fun.
Laureen: That’s how you should write it in your exam booklet. Identify all the burns and then like… now so this is for the 948 code. And then for the actual code, we realize this is in the same group so it’s going to be a 942. What’s the worse one? .3 and then we need to use you know, for the multiple. So in this case, you’re only going to have the 2 codes. Normaly, this one goes first and 948 goes second.
And then just to finish up the discussion, if you have multiple, multiple burns like you can’t fit them in the number of slots that you have, there is code 946 which is burns of multiple specified sites. So if you’re going to use that category, obviously, they’re not going to use location because you’re saying it’s multiple but you use the same 4th digits.
Okay so that is burn coding.
Alicia: I might mention real quick too though when someone sees you do the math, it isn’t that you… that’s like the extent of math you do as a coder. That and adding your… the size of lesion that’s removed. So it’s minimal, minimal math. You deal with numbers all day but you don’t have to do math.
Alicia: Because some people are scared of math.
Laureen: Yes, I know. But you have to do a little bit of math. Someone on the chat said, “I love it when Alicia draws pictures in class.”
Alicia: I’m a big picture drawer, yeah.
Laureen: Okay yeah, my artwork is more laughable but memorable.
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