Example

Diagnostic Statement: Burns over 65% of body with 28% of the body involved in thirddegree and 37% involved in second-degree Burn, unspecified site (multiple):
Burn, TBSA Burn, third-degree (28%):

949.0
948.6 948.62

CODING GUIDELINES FOR BURNS

940-948
Before you assign a diagnosis code, you will need to know:
Location Site Face, head Degree Degree First, Second, Third Precise Location Location (Lip) % Body Surface Total Body Surface (any degree) % 3rd Degree

CODING GUIDELINES FOR BURNS BURN SITE 941-946

1. SITE - First, you should use codes 941-946 "to code the burn by body location"
For example: if a patient has a burn on her hand, you know to begin your coding with the 944 series.

CODING GUIDELINES FOR BURNS

BURN DEGREE 941-946

2. DEGREE - When reporting a diagnosis from the 941946 series, you must select a fourth digit.
Codes 941-946 each list six fourth-digit options to indicate the degree of the patient's burn: 0 (unspecified) 1-3 (first, second or third degree) 4 (deep necrosis of underlying tissues without mention of loss of a body part) and 5 (with loss of a body part).

CODING GUIDELINES FOR BURNS

BURN LOCATION 941-946

3. LOCATION - Codes 941-945, you must also assign a fifth digit to indicate the precise location

of the patient's burn.

Example: The patient has a second-degree burn on his ankle. You would report 945.23 (Burn of lower limb(s); blisters, epidermal loss (second degree); ankle).

CODING GUIDELINES FOR BURNS BURN DEPTH

Burn Depth
Burns Depth are classified in three degrees: 1. First 2. Second 3. Third

CODING GUIDELINES FOR BURNS BURN/FIRST DEGREE

First Degree
Superficial burns involving only the top layer of the skin (epidermal layer). First-degree burn is the least serious

Second Degree
Involve the middle layer of the skin (dermal layer). Two types of second degree burns Superficial partial thickness and; Deep partial-thickness burns

CODING GUIDELINES FOR BURNS BURN/THIRD DEGREE

Third Degree

Third degree Burns involve all three layers of skin (epidermis, dermis, and fat layer), usually destroying the sweat glands, hair follicles, and nerve endings.

Third-degree burns, also called fullthickness Burns, injure all the layers of the skin including the fatty tissue beneath them.
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Sequencing of Burn and Related Condition Codes

CODING GUIDELINES FOR BURNS

CODING THE DEGREE OF A BURN: If there are varying degrees of a burn within the same general site, (three digit level), code to the highest or most severe degree.
FOR EXAMPLE: If a patient suffered first and second degree burns on the left forearm, use only code 943.21, showing the second degree burns.
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Sequencing of Burn and Related Condition Codes

CODING GUIDELINES FOR BURNS

Multiple Codes and Sequencing

When a patient have multiple burn sites, code all of the sites separately. If you are also using codes for other injuries and you are limited by the number of codes you can use for the burns, you can use a 946 code to indicate multiple burns. If a patient's burn becomes infected, be sure to also use code 958.3, post-traumatic wound infection. Sequence the most severe burn first.
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CODING GUIDELINES FOR BURNS Code 940-949

Code 940-949

electricity, flames, hot objects, lightning, radiation, internal and external burns and scalds.

Used for burns from electrical appliances,

The criteria used to code burns are:

Site Percentage of body surface involved (area), And degree of burn

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CODING GUIDELINES FOR BURNS Code 940-945

Code 940-945 (site, external organs)

Used in coding burns by Site. The first three digits for each code indicate the general section of the body. Example: Code 944 covers the wrists,

hands, fingers and thumbs.

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CODING GUIDELINES FOR BURNS Code 940

Code 940

Covers burns confined to the eye and adnexa, the fourth digit specifies both: The type of burn and; The exact location of the burn within the eye or adnexa. Example: A chemical burn (acid) to the cornea, would be coded 940.3.
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CODING GUIDELINES FOR BURNS Code 941- 945

Code 941- 945

The Fourth digit specifies the depth of the burn The Fifth digit specifies the exact location

EXAMPLE: A second degree burn to the chest wall, would be coded 942.22.

The First three digits, 942, indicate the general trunk, chest and abdominal walls, back, and genitalia area. The Fourth digit of two indicates that the burn was a second degree burn, The Fifth digit of two indicates that the burn was specifically to the chest wall
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CODING GUIDELINES FOR BURNS BURNS/MULTIPLE SITES

Code 946 (multiple sites, external)

Code 946 is used for burns that are classifiable to more than one three digit code from 940 to 945. Code 946 is used when there are multiple specified sites. The fourth digit for this code specifies the degree of burn.

Example: 946.2 Burns of multiple specified sites, second degree.

The fourth digit 2 indicate that the burn is second degree.

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CODING GUIDELINES FOR BURNS 947/BURN OF INTERNAL ORGANS

Code 947 (site, internal organs)

Used for burns to the internal organs due to ingestion of a chemical agent. The fourth digit specifies the exact site of the burn.

EXAMPLE: Code 947.2, indicates a burn to the

esophagus.

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CODING BURNS BURN/SITE, DEGREE & LOCATION

941
Site
(Burn, face, head, neck

2
Degree (Second)

3
Location (Lip)

941.23 second degree burn to the Lip

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CODING BURNS DETERMINING BURN SEVERITY

Burn Severity

The severity determines how burns are predicted to heal and whether complications are likely Doctors determine the severity of the burn by estimating the percentage of the body surface

that has been burned.

Calculated by using rule of nines

The rule is based on the body surface area burned

It bases the percentage assigned on the number nine
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WHAT IS THE RULE OF NINES?

Estimates extent of burns

Head and neck - 9% Each arm - 9% Each leg - 18% Anterior trunk - 18% Posterior trunk - 18% Genitalia - 1% May estimate small children or overweight adults differently
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948/TOTAL BODY SURFACE AREA (TBSA)

CODING GUIDELINES FOR BURNS

Code 948 (area/extend of the body surface)

Used to classify burns according to the extent of

the body surface area involved. burn is unspecified

This code can be used by itself when the site of the

Code 948 can also be used in conjunction with a code from 940 to 947 to further describe the

patient's condition.

Requires both a Fourth and a Fifth Digit.

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948/TOTAL BODY SURFACE AREA (TBSA)

CODING GUIDELINES FOR BURNS

Code 948 (area/extend of the body surface) Continue The Fourth Digit specifies the total percent of the body surface burned (at any degree)

The Fifth Digit specifies the percent of the body surface with third degree burns.

EXAMPLE: If 30 percent of the patient's body surface has second degree burns, but the site of the burns is unspecified, use code 948.30. The Fourth Digit of 3 indicates that 30 percent of the body is burned. The Fifth Digit of 0 indicates that no part of the body received Third Degree burns.
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WHAT IS THE RULE OF NINES?

CASE STUDY

Diagnostic Statement:

A 35-year-old man is seen for third degree burns to the left foot, ankle, and anterior surface of upper leg, and second degree burns to the left forearm, elbow, and upper arm caused from a flame while refueling his dune buggy.
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WHAT IS THE RULE OF NINES? CASE STUDY

1. Multiple sites, lower limb, third degree burns: 2. Multiple sites, upper limb, second degree burns: 3. Percent TBSA : 945.39 943.29 948.1

4. Percent TBSA 3rd degree (body surface not specified): 948.10

5. Accident caused by ignition of gasoline :

E894

Rationale: Each arm equals nine percent; one leg equals 18 percent; however, burn limited foot, ankle and anterior surface of upper, which is estimated at 9 percent of e n t i re leg surface. This total is 19 percent TBSA. The leg suffered the third degree burns.

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CODING GUIDELINES FOR BURNS BURN/UNSPECIFIED SITE

Code 949 (Unspecified site)

Used for burns for which the Degree of the burn is known but the Site is not. The fourth digit indicates the degree and

specifies whether or not a body part was lost.

Use a 948 code if the percent of surface area is known. 24

CODING GUIDELINES FOR BURNS BURN/INFECTED WOUND

Code 958.3 (Infected wound)

Assign Code 958.3, Posttraumatic wound infection, not elsewhere classified, as an additional code for any documented infected burn site.

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EXTERNAL CAUSES OF BURNS E849/PLACE OF OCCURRENCE

E Codes can document how/where burns occurred

Category E849: Documents place of occurrence

Accidental

If the burn is accidental, report an E Code. ICD-9-CM classifies accidents caused by fire and flames to E890-E899. Look in E924.x (accident caused by hot substance or object, caustic or corrosive material, and steam) for codes describing accidental burns from hot objects.

EXAMPLE: If a patient accidentally burns herself with boiling water, use E924.0 (. . . hot liquids and vapors,

including steam).

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LATE EFFECTS
906.5 to 906.9

Late Effects of Burns

Treatment of late effects of burns should be coded to the residual condition (such as scars or contractures) followed by the appropriate late effect of burn code (906.5 to 906.9).

may be used on the same record.

Late Effects and current burn codes

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CASE STUDY
Diagnostic Statement: Patient has a cicatrix of left hand, due to accidental burn that occurred 1 year ago from a bonfire.
Cicatrix: Late effect of burn of wrist & hand: 709.2 906.6

Late effect of accident caused by fire:

E929.4

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CASE STUDY
Diagnostic Statement: Patient is being treated for avascular necrosis following previous scaphoid fracture due to old sports injury with fall.
Other Aseptic necrosis of bone:
Late effect of fracture of upper extremities:

733.49 905.2

Late effect of accidental fall:

E929.3

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DEBRIDEMENT

Debridement of Wound, Infection, or Burn

Debridement is a medical term referring to the removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue.

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Type of Debridement

Two Types of Debridement

1. Excisional Debridement Surgical removal or cutting away of devitalized tissue, necrosis, or slough.

Assign code 86.22

2. Nonexcisional Debridement Nonoperative brushing, irrigating, scrubbing, or washing of devitalized tissue, necrosis or slough. Assign code 86.28
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CASE STUDY Debridement/Excisional

Diagnostic Statement: Excisional debridement of infected burn right palm performed by physical therapist. Patient was burned by hot light bulb.
Unspecified Degree/Palm: Posttraumatic wound infection: Burn, by Light Bulb:
Excisional debridement of wound/infection or burn:

944.05 958.3 E924.8 86.22

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CASE STUDY
Debridement/Non-Excisional
Diagnostic Statement: Nonexcisional debridement of second-degree burn of the neck performed by physical therapist . Accidental burn from tanning bed at salon.
Burn to the neck/second degree: Burn/Tanning Bed: Public Building: 941.28 E926.2 E849.6

Nonexcisional debridement /infection or burn: 86.28

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EXAMPLE Coding Burns

Diagnosis: Third-degree burn of back, 40%, and second-degree burn of lower leg (15%); assault by fire at home.
Burn, back third degree:
Burn, lower leg, second degree: Assault by Fire

942.34
945.24 E968.0

Location of Assault
Percent TBSA : 55% Percent TBSA 3rd degree

E849.0
948.5 948.54
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CASE STUDY Coding Burns

Diagnostic Statement: Burn of trachea

from accidental ingestion of caustic substance.

Larynx, trachea, & lungs:

947.1

Unspecified corrosives and caustics:

E864.4

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CASE STUDY Coding Burns

Diagnostic Statement: Second-degree burns in factory fire determined to be arson. Blisters, epidermal loss (second degree):
(Assault by other & unspecified means)

949.2 E968.0

Fire:

Industrial place & premises:

E849.3

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CASE STUDY Coding Burns

Diagnostic Statement: First-degree burns,

10% body surface, arm

Burn, first degree (Erythema)/Arm:

943.10

Burn, area less the 10% Third-degree: 948.10

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CASE STUDY Coding Burns

Diagnostic Statement: Burn, second

degree, hand, Kitchen fire

Burn, hand, second degree: Place of Occurrence:

944.20 E849.0
38

Accidental caused of unspecified fire: E899

CASE STUDY Coding Burns

Diagnostic Statement: Burn second

degree: hand, 10%, Third-degree to the upper limb 30%

943.33
944.20 948.43
39

Burn, upper arm, third degree:

Burn, hand, second degree: TBSA/Third Degree = 30%:

Total Body Surface Area (TBSA)=40%: 948.4

CASE STUDY Coding Burns

Diagnostic Statement: Burn third degree:

multiple sites 40%, Burn second degree 35% : multiple sites

949.3 949.2

Burn, unspecified third-degree : Burn, unspecified second-degree :

Percentage of TBSA (75%)

Percentage of third-degree TBSA:

948.7
948.74
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CASE STUDY
GROUP EXERCISE CHALLENGE
Diagnostic Statement: Burn third degree to

forehead & cheek 20%, Burn second degree 14% to hand, 25% first degree burn to upper arm, Burn second-degree to the Groin 3%, infected third degree burn to the right lower leg, below the knee 36% with amputation. The accident was caused by an air tank explosion at home. The patient has a history of schizophrenia.
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CASE STUDY - ANSWERS Coding Burns

Burn, right leg third-degree (36%) Burn, third-degree forearm & cheek (20%) Burn, second-degree hand (14%) Burn, second-degree groin (3%) 945.54 941.37 944.20 942.23

Burn, first-degree upper arm (25%)

Posttramatic wound infection
Traumatic amputation of leg, unilateral, below knee, complicated

943.13
958.3 897.1 948.9 948.95 E921.1 E849.0 V11.0 42

Percentage of TBSA (98%) Percentage of third-degree (56%) Accident Caused gas cylinders/air tank Place of occurrence/home Personal History of schizophrenia

FINAL NOTE

Remember:

If a patient has no thirddegree burns, there is no need to report a 948 code in addition to the burn location code.

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