Okay, Burn coding.
This oneís for me.
A student asked us to review ICD coding for burns.
So if you have your coding manuals, Iím going to be turning to the tabular section of ICD
9 starting with code 940.
So at any rate, hereís the Burn category in ICD-9 and youíll see, just like all of
ICD, you get your includes and excludes list.
So it excludes friction burns, sunburnsÖ and they forgot one.
If you want to write it inÖ sideburns.
Hahaha.
I need a liveÖ 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, ìWait a minute.î
Alright so the first thing we need to identify with burns is weíve got these 3 digit categories.
So 940 Burn confined to (23.18).
And by the way, the range for the burn category, itís telling us, it goes from 940 to 949
so letís just get a lay of the land.
Whatís the difference between the categories, the 3 digits?
941 is burns of face, head and neck, and 942Ö Iím going to turn the page.
Boyd: Just watch your audio because youíre just dropping just a little bit.
Laureen: Oh yeah because Iím having to twist over to where my camera is.
Okay, Iím going to move my little microphone buddy here.
Too many papers.
Alright, can you hear me now?
Alicia: We can hear you good.
Laureen: Alright so 942, burn of the trunk.
So the difference between the 3Ö the categories is location, general location.
Now this is the point where Iíll ask my students, ìOkay what do we need to figure out next?
And theyíll say, ìOh is it the chest, the back or the genitalia?î Iím like, ìNo,
thatís 5th digit.î We canít 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.
Donít think that things go in order.
So whatís the difference between the 4 digits?
And what I love about this is that theyíre 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 thatís 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, weíre
going to say, okay 942 of the trunk and then the 3rd degree, itís going to be .3 and then
we come up to the 5th digit box.
Itís going to be 4.
So 942.34 is going to be the code for that.
Thatís pretty easy when you just have one burn.
Quite often, unfortunately, thereís multiple burns to contend with.
So what do you do when you have more than one burnÖ like, if I had a burn of the trunk
and a burn of the arm, Iím going to be in 2 different categories.
Iím 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?
Theyíre 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 itís 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 Iíve been here before.
Okay so what a common newbie mistake is theyíll say, ìOh, coding guidelines say I code the
worse burn.î So they code 942.3 and they use 4 for back when they miss the point that
they should have used 9 to indicate itís multiple burns in that category, the worse
one being a 3rd degree.
Okay so whenever youíre coding multiple burns in the same category, youíre only going to
have one code per category.
And if thereís more than one, youíre 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 Iím a mom.
If my kid got hurt and they got burned then Iím going to be like, ìWhat percent of their
body was affected?
Is it just their finger?
Okay, we can deal with that.î But if itís like you know, their whole arm or you know,
itís 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.
Theyíve got one of the baby.
Thatís a great thing to do by the way guys is you know, give yourself cross-references.
I always pretend like itís my pre-exam self writing notes to that self whoís going to
be taking the exam.
So when youíre taking the exam, youíre like, ìThank you Laureen for doing that.î
So at any rate, we go to 4th digit first and we will look at the 4th digit.
Weíve 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 thatís 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 itís
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 letís just say
thatís 18%.
And then we said the breast, 2nd degree and letís just call that, I donít 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 donít carry over the 15% or the 5% because thatís 2nd degree only.
So for the 5th digit, weíre going to be focused on the 18%.
4th digit, weíre going to be focused on the 23%.
So hereís a neat trick.
948, whatever the first number is, .21 because 20-29%, right?
Itís 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.
Isnít that a cool trick?
Alicia: I did not know that trick.
I am so excited to learn that.
Thatís fun.
Laureen: Thatís how you should write it in your exam booklet.
Identify all the burns and then likeÖ now so this is for the 948 code.
And then for the actual code, we realize this is in the same group so itís going to be
a 942.
Whatís the worse one?
.3 and then we need to use you know, for the multiple.
So in this case, youíre 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 canít fit them in the number of slots that you have, there is code 946 which is
burns of multiple specified sites.
So if youíre going to use that category, obviously, theyíre not going to use location
because youíre saying itís 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 isnít
that youÖ thatís like the extent of math you do as a coder.
That and adding yourÖ the size of lesion thatís removed.
So itís minimal, minimal math.
You deal with numbers all day but you donít have to do math.
Laureen: Great.
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, ìI love it when Alicia draws pictures in class.î
Alicia: Iím a big picture drawer, yeah.
Laureen: Okay yeah, my artwork is more laughable but memorable.
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