1. The Complete Diagnosis Coding Book by Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA Chapter 7 Coding Burns Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved McGraw Hill/Irwin

2. Learning Outcomes ·Abstract the notes to determine the site of the burn. ·Interpret the correct severity of the burn. ·Use the rule of nines to determine the body area involved. 7 - 2

3. Learning Outcomes ·Determine the correct E code or codes. ·Apply the guidelines for coding complications of burns. ·Correctly code the late effects of burns. 7 - 3

4. Introduction A patient can sustain a burn to any part of his or her body in many different manners: ·Flame ·Hot object ·Chemicals 7 - 4

5. Coding a Burn S/S.E.E. the burn when coding: ·Code 1 Site/Severity ·Code 2 Extent of the body affected ·Code 3 External cause (E code) 7 - 5

6. The Burn Code First Three Digits: Anatomical site ·940 Eye and adnexa ·941 Face, head, and neck ·942 Trunk ·943 Upper limb, except wrist and hand ·944 Wrist and hand ·945 Lower limb(s) 7 - 6

7. The Burn Code Fourth Digit: Degree (severity) of burn ·xxx.1 Erythema [first degree] ·xxx.2 Blisters, epidermal loss [second degree] ·xxx.3 Full-thickness skin loss [third degree NOS] 7 - 7

8. The Burn Code Fifth Digit: Specific anatomical site ·xxx.x1 Forearm ·xxx.x2 Elbow ·xxx.x3 Upper arm ·xxx.x4 Axilla ·xxx.x5 Shoulder 7 - 8

9. Multiple Sites Multiple sites burned on the same area coded by the same THREE-DIGIT code: Use one code with the Multiple sites fifth digit In other words, each THREE-DIGIT code subcategory can only be placed on a claim form ONCE. 7 - 9

10. Extent of Burn ·Code 948.xx: ·Fourth digit reports percentage of ENTIRE body with any burns of ALL degrees. ·Fifth digit reports percentage of ENTIRE body with Third-Degree burns ONLY. 7 - 10

11. Rule of Nines ·Used to estimate the total body surface area (TBSA) that has been affected by burns 7 - 11

12. External Cause Because a burn is an INJURY, you will need E codes to report: ·HOW the patient came to be burned. ·WHERE the patient was when he or she became injured. 7 - 12

13. Infection ·When a burn site becomes infected, it is considered a post-traumatic wound infection. ·Sequence this code AFTER the code for the burn and BEFORE the extent code. 7 - 13

14. Nonhealing Burns ·Regardless of how long ago the original injury occurred, an unhealed burn is to be coded as a Current Burn. 7 - 14

15. Late Effects ·Scarring and joint contractures are common late effects of a burn injury. ·These should be coded as late effects; the problem is the scar or contracture. 7 - 15

16. Chapter Summary ·Burn patients may be seen in a family practice, dermatologist’s office, emergency department, plastic surgery center, or specialized burn unit. ·There are many locations at which a coder might work and have to code burns. 7 - 16