Home

Cover Story

Table of Contents

E-Newsletter

Article Archive

Editorial Calendar

Datebook

Writers' Guidelines

Orgs/Links

Opinion Polls

Reprints

Search

For other articles and previous issues click here.

March 22, 2004

Coding for Burns
Vol. 16 No. 6 p. 42

Burns are classified to ICD-9-CM category codes 940 to 949, which include burns from electrical heating appliances, electricity, flames, hot objects, lightning, radiation, chemical burns, and scalds. The specific code assignment will depend on the site and depth of the burn.

Degrees of Burns
The following is a summary of the degrees of burns, which are identified by the fourth-digit subcategory in ICD-9-CM:
• A first-degree burn is the least serious. Only the outer layer of skin (epidermis) is burned, but not burned completely through. The skin is red (erythema), with swelling and pain sometimes present.
• A second-degree burn involves the first layer of skin and into the second layer of skin (dermis). Blisters develop and the skin takes on an intensely reddened, splotchy appearance. It will also cause severe pain and swelling. There are two types of second-degree burns, which include superficial partial-thickness and deep partial-thickness burns.
• A third-degree burn involves all layers of the skin (full thickness skin loss) and the tissue under the skin. Fat, muscle, and even bone may be involved, which may be documented as fourth-degree. Third-degree burns are painless and may appear as charred black or dry and white. They may also be accompanied by smoke inhalation. ICD-9-CM has separated third-degree burns at the fourth-digit subcategory to classify not otherwise specified, without mention of loss of a body part, and with loss of a body part.

Causes of Burns
The following are common causes of burns:
• heat burns (thermal burns), such as fire, steam hot objects, or hot liquids;
• electrical burns, which include contact with electrical sources or lightning;
• chemical burns, such as contact with household or industrial chemicals in a liquid, solid, or gas form;
• radiation burns caused by sun, tanning booths, sunlamps, x-rays, or radiation therapy for cancer treatment; and
• friction burns, which include contact with any hard surface, such as roads, carpets, or a gym floor surface. They involve both abrasion or heat burn.

Most burns are classified to categories 940 to 949. However, the following types of burns are classified elsewhere:
• Sunburn (692.71, 692.76, 692.77)
• Friction burns (go to superficial injury by site; 910 to 919 with 0.0 or 0.1 as fourth digit)
• Burn secondary to a tanning bed (692.82)

Coding Guidelines for Burns
The following is a summary of the coding guidelines for burns as listed in AHA Coding Clinic for ICD-9-CM, 2002, fourth quarter, pages 149 to 154:
• If more than one burn is present, sequence the highest-degree of burn first. Therefore, if a patient had a third-degree burn of the leg and a second-degree burn of the arm, the third-degree burn of the leg would be sequenced first.
• Code only the highest degree burn with burns of the same site (coded to the same category code) but different degrees. Therefore, if a patient had a first- and second-degree burn of the arm, assign only a code for the second-degree burn.
• Code nonhealing burns or necrosis of burned skin as acute burns by site and degree.
• Any infected burns would be classified to code 958.3, Posttraumatic wound infection, which would be sequenced as a secondary diagnosis.
• Multiple three-digit category codes should be assigned if the burn is of documented specified multiple sites. If the physician does not document the burn sites, assign a code from category 946.
• 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).
• Late effects and current burn codes may be used on the same record, if appropriate.

Category 948
A code from category 948, Burns classified according to extent of body surface involved, may be sequenced as the principal diagnosis when the site of the burn is not specified. However, coders are instructed to code the site of the burn first, when known. It can also be sequenced as a secondary diagnosis to provide additional information on the extent of body surface burned and what amount was third-degree.

In category 948, the fourth-digit subcategory classifies the percent of total body surface area burned and represents all degrees. The fifth-digit subclassification classifies the percentage of the body surface area burned that was third-degree. Only the percentage of third-degree burns is identified in the fifth-digit subclassification. It is the physician’s responsibility to document the total body surface area burned and what percentage is third-degree.

It is important to assign a code from category 948 as either the principal diagnosis or more frequently as the secondary diagnosis because it could make a difference between diagnosis-related group (DRG) assignments.

DRG Classifications for Burns
The DRG classifications for burns are based mainly on the following:
• Extensive — burns with a total body surface area burned of greater than 20% with greater than 10% of third-degree
• Full-thickness — other third-degree burns that do not qualify as extensive or nonextensive
• Nonextensive — first-degree or second-degree burns of specified body sites. Also includes unspecified sites with less than 10% total body surface area being third-degree (948.x0).

A code from category 948 will determine whether the burn is extensive or nonextensive and will drive the DRG assignment if sequenced as either the principal diagnosis or secondary diagnosis.

Other aspects that determine the DRG assignment include the presence or absence of a significant trauma, inhalation injury, including respiratory failure, complication or comorbidity, or skin graft procedure. The only set of procedures that will affect DRG assignment for burns is skin graft procedures. Excisional debridement (86.22) will no longer affect DRG assignment.

Coding and sequencing for burns are dependent upon the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Health Information Systems (800-367-2447), a leading supplier of coding and classification systems to nearly 4,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information.

Subscribe to For the Record Magazine!