1. Apply and assign the correct ICD-9-CM and ICD-10-CM codes in accordance with Official Guidelines for Coding and Reporting 2. Identify major differences between ICD-9-CM and ICD-10-CM related to burns, adverse effects, and poisonings 3. Identify the various types of burns 4. Differentiate between an adverse effect and a poisoning 5. Assign the correct V/Z codes, E codes, and procedure codes related to burns, adverse effects, and poisonings 7. Explain the importance of documentation in relation to MS-DRGs for reimbursement Please refer to the companion Evolve website for the most current guidelines. 17. Chapter 17: Injury and Poisoning (800-999) 1) Sequencing of burn and related condition codes Sequence first the code that reflects the highest degree of burn when more than one burn is present. a. When the reason for the admission or encounter is for treatment of external multiple burns, sequence first the code that reflects the burn of the highest degree. b. When a patient has both internal and external burns, the circumstances of admission govern the selection of the principal diagnosis or first-listed diagnosis. c. 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 or first-listed diagnosis. 2) Burns of the same local site Non-healing burns are coded as acute burns. Necrosis of burned skin should be coded as a non-healed burn. 4) Code 958.3, Posttraumatic wound infection 5) Assign separate codes for each burn site Category 949, Burn, unspecified, is extremely vague and should rarely be used. 6) Assign codes from category 948, Burns In assigning a code from category 948: Fifth-digits are assigned to identify the percentage of body surface involved in third-degree burn. 7) Encounters for treatment of late effects of burns 8) Sequelae with a late effect code and current burn d. Coding of Debridement of Wound, Infection, or Burn For coding purposes, excisional debridement is assigned to code 86.22. Nonexcisional debridement is assigned to code 86.28. e. Adverse Effects, Poisoning and Toxic Effects (a) Error was made in drug prescription (b) Overdose of a drug intentionally taken (c) Nonprescribed drug taken with correctly prescribed and properly administered drug (d) Interaction of drug(s) and alcohol g. SIRS due to Non-infectious Process a. General E Coding Guidelines 7) External cause code(s) with systemic inflammatory response syndrome (SIRS) An external cause code is not appropriate with a code from subcategory 995.9, unless the patient also has another condition for which an E code would be appropriate (such as an injury, poisoning, or adverse effect of drugs). b. Place of Occurrence Guideline Do not use E849.9 if the place of occurrence is not stated. c. Adverse Effects of Drugs, Medicinal and Biological Substances Guidelines 1) Do not code directly from the Table of Drugs Do not code directly from the Table of Drugs and Chemicals. Always refer back to the Tabular List. 2) Use as many codes as necessary to describe Use as many codes as necessary to describe completely all drugs, medicinal or biological substances. 3) If the same E code would describe the causative agent 4) If two or more drugs, medicinal or biological substances 5) When a reaction results from the interaction of a drug(s) 6) Codes from the E930-E949 series d. Child and Adult Abuse Guideline Apply the General Coding Guidelines as found in Chapter 5 and the Procedural Guidelines as found in chapter 6. At the beginning of Chapter 17 in the ICD-9-CM code book, special instructions say, “Use E code(s) to identify the cause and intent of the injury or poisoning (E800-E999)” (Figure 24-1). Please refer to the companion Evolve website for the most current guidelines. 19. Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88) d. Coding of Burns and Corrosions 1) Sequencing of burn and related condition codes Sequence first the code that reflects the highest degree of burn when more than one burn is present. a. When the reason for the admission or encounter is for treatment of external multiple burns, sequence first the code that reflects the burn of the highest degree. b. When a patient has both internal and external burns, the circumstances of admission govern the selection of the principal diagnosis or first-listed diagnosis. c. 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 or first-listed diagnosis. 2) Burns of the same local site Non-healing burns are coded as acute burns. Necrosis of burned skin should be coded as a non-healed burn. For any documented infected burn site, use an additional code for the infection. 5) Assign separate codes for each burn site 6) Burns and Corrosions Classified According to Extent of Body Surface Involved 7) Encounters for treatment of sequela of burns 8) Sequelae with a late effect code and current burn 9) Use of an external cause code with burns and corrosions e. Adverse Effects, Poisoning, Underdosing and Toxic Effects 1) Do not code directly from the Table of Drugs Do not code directly from the Table of Drugs and Chemicals. Always refer back to the Tabular List. 2) Use as many codes as necessary to describe Use as many codes as necessary to describe completely all drugs, medicinal or biological substances. 3) If the same code would describe the causative agent 4) If two or more drugs, medicinal or biological substances 5) The occurrence of drug toxicity is classified in ICD-10-CM as follows: Examples of poisoning include: (i) Error was made in drug prescription (ii) Overdose of a drug intentionally taken (iii) Nonprescribed drug taken with correctly prescribed and properly administered drug (iv) Interaction of drug(s) and alcohol See Section I.C.4. if poisoning is the result of insulin pump malfunctions.
Burns, Adverse Effects, and Poisonings
(ICD-9-CM Chapter 17, Codes 800-995, ICD-10-CM Chapters 19 and 20, Codes S00-Y99)
ICD-9-CM Official Guidelines for Coding and Reporting
ICD-10-CM Official Guidelines for Coding and Reporting
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