Part 1: Workbook Ch. 3 16. Established 50 year old patient with end-stage renal disease, is seen for acute left upper quadrant pain.
First listed diagnosis: Left upper quadrant abdominal pain Code: R10.12 Other Diagnosis: End-Stage Renal Disease Code: N18.6 Other Diagnosis: Dialysis Status Code: Z99.2
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How to code Burns and Corrosion using the ICD-10-CM medical coding book A patient can sustain a burn or corrosion to any part of the body in many different ways. It can be the result of the skin coming near or in actual contact with a flame, such as a candle or a gas stove. A burn can happen when contact is made with a hot object, such as a hot plate or curling iron. Chemicals, such as lye or acid, can cause corrosion upon contact with a person’s skin. As a professional coding specialist, you may need to code the diagnosis of a burn or corrosion. In such cases, you have to "S/S.E.E." the burn to code it correctly. This acronym can help you remember what details you need, the minimum number of codes you need, and the order in which to report them. You need at least three codes to properly report these diagnoses: First-listed code(s): S/S for site and severity (from categories T20-T25) Next listed code: E for extent (from code category T31) Lastly, code(s): E for external cause code(s) In ICD-10-CM, you will also need to report a code for each separate burn or corrosion site. Let’s take a closer look at these components and what they mean. Each of these codes will require seven characters, so we'll take a look at what those characters represent. Site Your first-listed code will be a combination code that report both the site and severity of the injury. Site refers to the anatomical location that is affected by the burn or corrosion. The descriptions of codes in the T20-T28 range are first defined by a general part or section of the human body: T20, burn and corrosion of head, face, and neck T21, burn and corrosion of trunk T22, burn and corrosion of shoulder and upper limb, except wrist and hand T23, burn and corrosion of wrist and hand T24, burn and corrosion of lower limb, except ankle and foot T25, burn and corrosion of ankle and foot T26, burn and corrosion confined to eye and adnexa T27, burn and corrosion of respiratory tract T28, burn and corrosion of other internal organs Severity The fourth character for each category identifies the severity (except categories T26-T28). Using the layers of the skin, the severity of a burn is identified by degree: First-degree burns are evident by erythema (redness of the epidural layer) Second-degree burns are identified by fluid-filled blisters in addition to erythema Third-degree burns have damage evident in the epidermis, dermis, and fatty tissue layers and can involve the muscles and nerves below Deep third-degree burned skin will show necrosis (death of the tissue) and at times, may result in the loss (amputation) of a body part The fourth characters available in this section give you the ability to report the documented severity of the burn or corrosion. Those choices are: 0, unspecified degree 1, erythema (first degree) 2, blisters, epidermal loss (second degree) 3, full-thickness skin loss (third degree not otherwise specified) 4, corrosion of unspecified degree 5, corrosion of first degree 6, corrosion of second degree 7, corrosion of the third degree Specific site The fifth character enables you to report additional details regarding the anatomical site of the burn. Of course, these details will change in accordance with the anatomical region of the code category. Let’s take a look at a sample from code category T23.1- (burn of first degree of wrist and hand): T23.10-, burn of first degree of hand, unspecified site T23.11-, burn of first degree of thumb (nail) T23.12-, burn of first degree of single finger (nail) except thumb T23.13-, burn of first degree of multiple fingers (nail), not including thumb T23.14-, burn of first degree of multiple fingers (nail), including thumb T23.15-, burn of first degree of palm T23.16-, burn of first degree of back of hand T23.17-, burn of first degree of wrist T23.19-, burn of first degree of multiple sites of wrist and hand Each degree of burn and corrosion is set up in a similar manner, and the sixth character will represent laterality: 1, right 2, left 9, unspecified Multiple sites fall into the same category When various sites fall into the same code category (the first three characters of the code), you will report just one code, using the last character to identify multiple sites. If the burns are of different severity, use the fourth character that reports the burn of the highest degree (the most severe). Extent Next, you will report the extent, or percentage, of the body involved using a code from category T31 to report a burn or T32 to report a corrosion. This code will require a total of five characters to be valid no matter what the extent of the burn. These codes should only be reported as the first-listed code when the physician does not specify the site of the burn. Otherwise, codes from these categories are supplementary codes. Turn to category T31 in the ICD-10-CM Tabular List. You’ll notice that the required fourth character will identify the percentage of the patient’s entire body that is affected by any and all burns, of all degrees (severity). The code descriptions describe this as percentage of body surface, also known as TBSA (total body surface area). The physician may specify the percentages directly in his or her notes. Statements such as, “third-degree burns over 10% of the body” or “7% of the body burned” will give you the information you need to find the correct fourth character for categories T31 or T32. However, the physician may not use a number, and you will have to calculate the percentage yourself. To do this, you can use the rule of nines to estimate the TBSA that has been affected by the burns. The body is divided into sections, each section representing 9% of the human body. The sections include: Head and neck 9% Arm, right 9% Arm, left 9% Chest 9% Abdomen 9% Upper back 9% Lower back 9% Leg, right, anterior (front) 9% Leg, right, posterior (back) 9% Leg, left, anterior (front) 9% Leg, right, posterior (back) 9% Genitalia 1% As you read through the physician’s notes, be aware of the anatomical site, not only for your site code but also for your use to calculate the extent of the body involved in the burn or corrosion. Next, you must determine the most accurate fifth character for the T31 or T32 code. The fifth character identifies the percentage of the patient’s body that is suffering with third-degree burns or corrosions only. You can also use the rule of nines to find the best fifth character. Of course, these percentages are general—to be used for estimation purposes. As you look at the code descriptions for the fourth and the fifth characters, you will see that choices for code T31 and T32 all have descriptors that only require you to know the percentage of the body involved within a 10% range. Therefore, you don’t have to worry too much about narrowing down the number. Infection in the burn site If not treated properly, a burn site can become infected. It can happen because the inner layers of the tissue are exposed, and it might be difficult to keep the wound clean and sterile. If an infection occurs, you should add a code for the specific pathogen. Sequence the infection code after the burn code, but before the T31 or T32 code. Solar and radiation burns When a patient has been burned, not by fire or chemicals, but by some kind of radiation, the injuries are not reported with codes from the T20-T28 range. Instead, these burns will be reported using categories L55 and L56. Even with all the ads promoting sunblock lotions and ointments to protect the skin, individuals still get sunburns. These burns are also identified in three degrees to report damage to the skin as a result of overexposure to the natural sun, and each has its own code: L55.0, sunburn first-degree sunburn L55.1, sunburn of second degree L55.2, sunburn of third degree L55.9, sunburn unspecified Some individuals have a hypersensitivity to the sun, similar to an allergic reaction. The physician may diagnosis the patient with a photoallergic or phototoxic response to the sun. This type of severe reaction can be an effect of solar radiation and is reported with one of the following codes: L56.0, drug phototoxic response L56.1, drug photoallergic response L56.2, photocontact dermatitis (berloque dermatitis) L56.3, solar urticaria Certain medications can cause a patient to develop a sun sensitivity. For these cases, you will need to add an external cause code to report the specific drug that caused this situation. Sequelae (late effects) of burns and corrosions Often, a scar or contracture will develop at the site of a healed burn or corrosion. At times, this lasting condition requires treatment. In these cases, you will report the original burn or corrosion code using a seventh character S for sequela to identify the care and treatment is directed at the late effect of the burn or corrosion, and not the original injury.
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