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Question: My anesthesiologist administered anesthesia for a burn excision on the leg of a middle-aged adult male, but he didn’t give clear notes on the patient’s affected body surface area. How do I code for this? Kansas Subscriber Answer: You will start by coding 01952 (Anesthesia for second- and third-degree burn excision or debridement with or without skin grafting, any site, for total body surface area [TBSA] treated during anesthesia and surgery; between 4 percent and 9 percent of total body surface area) and add +01953 ( . . . each additional 9 percent total body surface area or part thereof [List separately in addition to code for primary procedure]) as necessary. Next, you’ll need to don your Sherlock Holmes hat. You’ll need find documentation of the patient’s affected total body surface area (TBSA). The attending surgeon typically … documents the TBSA of the burn victim. The history and physical (H&P) portion of the surgeon’s documentation may have an anatomic chart showing the burn area. Alternately, you can call the surgeon’s office, and code based on what they are billing. Physicians determine TBSA percentage using “The Rule of Nines.” To help determine the extent of burn wounds, doctors divide the body into 11 sections of 9 percent (99 percent) with the genitals adding the missing 1 percent. The sections break down as follows:
Note that the arms represent 4.5 percent on the anterior and 4.5 percent on the posterior. In contrast, each leg is 9 percent on the anterior and 9 percent on the posterior. Knowing these “rules” may help you decipher reports when coding for your anesthesiologist. You can find the reference diagram in your CPT manual under code 16000 (Initial treatment, first degree burn, when no more than local treatment is required). Important note: You should use +01953 as an add-on. A CPT parenthetical note dictates that you can’t skip 01951 (… less than 4% total body surface area) or 01952 just to get to the add-on code. Educate your anesthesiologist to document the extent of the burn. As always, you should review CPT guidelines for the burn codes and check them against the anesthesia codes to be sure you are using the appropriate codes based on the percentage of the body that was actually debrided. @ Anesthesia & Pain Management Coding Alert Be an anesthesia and pain management coding hero. Attend the Prepare for 2010 Anesthesia Changes, presented by expert Joanne Mehmert. Join the coding community at the Supercoder Fan Page. Related articles:
Each month, IBC will feature an example of how ICD-9 codes will translate to ICD-10 codes. We will present coding examples from different specialties and popular disease categories to demonstrate the granularity that the new ICD-10 code set will provide. CODING CONVENTION: ICD-10 coding burns and corrosions (continued from last month) This article will convey the coding conventions used in assigning the appropriate codes for burns and corrosions. ICD-10 makes a distinction between burns and corrosions. In addition to the distinction, there are coding conventions that are essential in attaining the correct code assignment. These conventions include: Sequencing When more than one burn/corrosion is present, sequence the code that reflects the highest degree first. When the reason for the admission or encounter is for treatment of external burns/corrosions, sequence the code that reflects the highest degree first. When a patient has both internal and external burns/corrosions, the circumstances of admission govern the selection of the principal diagnosis (i.e., first-listed diagnosis). When a patient is admitted for burn injuries and other related conditions such as smoke inhalation and/or respiratory failure, the circumstances of admission govern the selection of the principal diagnosis. Burns/corrosions of the same local site Classify burns of the same local site, but of different degrees, to the subcategory identifying the highest degree recorded in the diagnosis. Non-healing and infected burns/corrosions Non-healing and necrosis (death) of burned skin should be coded as acute burns. For any infected burn site, use an additional code for the infection. Assign separate codes for each burn site When coding burns, assign separate codes for each burn site. Category T30, ?Burn and corrosion, body region unspecified,? is extremely vague and should rarely be used. Extent of body surface involved (categories T31, T32) Burns and corrosions classified according to extent of body surface involved should be assigned when the site of the burn is not specified or when there is a need for additional data such as evaluating burn mortality (usually needed by burn units), and when there is mention of a third-degree burn involving 20 percent or more of the body surface. Categories T31 and T32 are based on the classic ?Rule of Nines? in estimating body surface area that has been burned. The Rule of Nines is a system that is based on the rough approximation that each arm has 9 percent of the body?s total skin, the head and neck have 9 percent, each leg 18 percent (two 9s), the front of the torso 18 percent, the back of the torso 18 percent, and the genitalia 1 percent.* *Providers may change these percentage assignments where necessary to accommodate infants and children who have proportionately larger heads than adults, and patients who have large buttocks, thighs, or abdomen that involve burns. Encounter for treatment of sequela of burns/corrosions Encounters for the treatment of late effects of burns/corrosions (i.e., scars or joint contractures) should be coded with a burn or corrosion code with the 7th character ?S? for sequela. Sequela and current burn Burns and corrosions do not heal at the same rate. A current healing wound may still exist with sequela of a healed burn or corrosion. Therefore, when both a current burn and sequela of an old burn exist, both a code for a current burn or corrosion with the 7th character ?A? or ?D? and a burn or corrosion code with ?S? may be assigned on the same record. Use of external cause code with burns and corrosions An external cause code should be used with burns and corrosions to identify the source and intent of the burn, as well as the place where it occurred. Example: Burns of the same local site Same local site Trunk Degree Sequencing Subcategory Chest Wall 1st degree Secondary diagnosis code Subcategory Abdominal Wall 2nd degree Principal diagnosis code For additional information related to the IBC transition to ICD-10, please visit the ICD-10 section of our website. On this site you will also find other examples of how ICD-9 codes will translate to ICD-10 codes in the ICD-10 Spotlight: Know the codes booklet. Which of the blocks on the CMS 1500 claim form is used to bill ICD codes?Effective Oct. 1, 2015, Field 21 of the CMS 1500 form will require an indicator of “9” or “0.” This indicator is for the purposes of the ICD-10 implementation. Entering a “9” will indicate the provider intends to submit ICD-09 codes. Entering a “0” will indicate the provider intends to submit ICD-10 codes.
When submitting claims Which of the following is the outcome if Block 13 is left blank?Test/Quiz questions. Which of the following describes the term crossover as it relates to Medicare?A crossover claim is a claim for a recipient who is eligible for both Medicare and Medicaid, where Medicare pays a portion of the claim, and Medicaid is billed for any remaining deductible and/or coinsurance.
Which of the following describes a claim that is 120 days old?Which types of claims is 120 days old? Delinquent. A nurse is reviewing a patient's lab results pior to discharge & discovers an elevated glucose level.
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When coding a front torso burn Which of the following percentages should be coded?
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