[Music] foreign [Music] true true [Music] [Music] foreign [Music] [Music] [Music] foreign so I'm ready to move on to some Burns yeah let's talk now we've got some burn ftrs burn fraction facts to remember and what are they well there are some definitions first you need to know that a burn includes thermal Burns and these are burns from heat Source such as fire electricity or radiation and in this chapter you're also coding for corrosions and corrosions or Burns acquired through chemicals or contact with chemicals now sunburns are not coated in this chapter sunburns are coated in the skin chapter right they're coded in chapter what is skin is it 12 I'm not sure but not here not here and also too we're going to review some guidelines but I want to let you know that you are free to go ahead and tap in your tabular list so this is a guideline that we're going to review here but feel free I love this section because you've got images of the degree of burns we're going to talk about first degree second degree and third degree burns but here's a reference right yeah so the first image is normal skin the second represents first degree and it's just pretty much um the epidermis is burned so it's superficial this burn is superficial and often doesn't need treatment emergent treatment but sometimes they do depending upon where you get burned also second degree burns involve the epidermis and the dermis right yeah and you can see the the picture shows that there's some redness swelling and also the skin looks like it has trauma to it yeah now when we get to the third degree burn that's pretty bad so it's going all the way down through the subcutaneous it could even get to the Bone so that's pretty extensive so when you think about it you will be coding these Burns according to the severity so the third degree burn will take precedence or be sequenced before the second and the second before first just thought I would tell you now let's get into the guidelines all right so here is a clipping from your MCG manual guideline c19.d1 and this and these guidelines are in order so you know you shouldn't be asking what page is c19.d1 you can just go ahead and just go in order you know you're in chapter 19 just go in order and even if you have an old MCG you still should be able to find the guideline that way now this is how you code and sequence Burns number one you're going to code them according to the location on the body number two the severity or the degree of the burn you're going to code the more severe first and of course that's the third then the second then the first degree also you will code the extent or the external cause of the body surface area or the total body surface area it's called ebsa or tbsa previously it was called tbsa and a lot of players in medical coding still call it tbsa but in your book it's going to say ebsa and then you're going to code the agent or external cost code and it gives you more in-depth description of how that burn occurred and where it occurred all right let me see is there anything else yep sequencing make sure you sequence the more severe first and also if there are multiple Burns of different degrees you're going to sequence the highest degree first but if you have multiple Burns in the same area multiple degree burns in the same area you're only going to sequence or code that highest degree okay all right and don't forget this is guideline c19 Point d and I just got ahead of myself if you have multiple burns with this in the same anatomic site c19 Point D2 foreign and you're going to code only the most severe so multiple burns on the same anatomic site and they're different degrees only code the most severe degree and one more thing I want to talk to you about I want to talk to you about the rule of nines the rule of nines is what they call the percentages your body percentages right and these are significant when you're coding for the ebsa and the tbsa right so you don't have to remember this because you can just write this down and also some of your icd-10-cms have the um the rule of nines documented so you'll see an image with the rule of nines but generally this is what it is this um part of your body and you know I want to see what you can see so I'm going to just take a moment to see something I want to see if you can see my you who can see if you can see my pointer let me know talk in the chat when I scroll my point around like this oh yeah so you can see it awesome all right so this part of the body thank you so much this part of the body is your trunk right and if you burn the entire front of your trunk that's 18 and I know it looks like the man is backwards but he is backwards right so if you burn the back of his of the trunk that's 18 if you burn the front the entire um front of your trunk that's 18 of your body if you burn your entire arm that's nine percent of your body the other arm nine percent your entire leg is 18 percent entire leg 18 percent in the genitalia one percent and the head and neck are nine percent all right and sometimes you're going to see drawings that you know carve out carve them out differently you know they may say you might see um nine percent for the upper leg nine percent for the lower you know nine percent for the whole leg excuse me three upper three lower I don't know but they'll have their own little numbers but nine percent for the whole leg the whole back leg nine percent of the other so it's not going to be that like that for the exam you're not going to have to calculate things often they'll give you the body area thank goodness but if anyone says what are the rule of nines you can give them this this is easy all right I think that's what we need let's get started we have some coding to do and if you remember this is how we solve scenarios moving forward and I'm talking about after this class all right highlight eliminate and determine your first listed and or not and first listed or your principal diagnosis all right so you have two minutes to solve it after I read it he has 30 percent tbsa burned with 11 third degree hmm a t21.30 XA t24.239 a x 0 8.11 x a b t 2 1.33 x a t24.209 a T3 1.31 x 0 8.11 a c t 2 1.33 x a t24.239 x 0 8.11 x A and D t21.30 X a t24.209 a T3 1.31 x 0 8.11 x a a patient suffers second-degree burns to his leg and the third degree burn and third degree burns to his back from a fire resulting after he fell asleep on the sofa while smoking and remember he has 30 percent tbsa burned with 11 third degree all right your time begins now all right you all are rocking it the majority of you said the same thing again you don't need me you are are rocking and hopefully you're using your MCG manual that should help with the guidelines all right so I'm going to get started I don't know how that clock leaves but maybe it's just gonna stay all right so this patient has second degree burns to the leg third degree burns to the back from a fire he fell asleep on the sofa while smoking and has a 30 percent total body surface area burned with 11 third degree hmm all right so these are the key words all right I gotta reference my guidelines and again use your MCG first I'm going to sequence my highest severity burn then the next then the next and then I'm going to sequence my tbsa or ebsa and then I'm going to sequence my external causes so if we're looking at these codes we know we have a second degree of the leg and third degree of the back so I can't really tell what's what I'm looking at C the second code doesn't have a seventh character extender so maybe that's eliminatable right away and also this total body surface area code it should be it should start with a t31 or a t32 and you only list these tbsa or ebsa codes when it's listed so if it's not given you can't code it but it is coded here and I see that a is coding for tbsa excuse me B is coding for tbsa and so is d hmm so what's not coding for it A and C all right I just thought I would say that and it's important that you pay attention to it because it could help you so because it's that important let's go ahead and let's deal with this 30 tbsa burned so we know a is missing the tbsa and so is C so now all we have to do is work with b and d so let's go to our category T to one burn and corrosion and also don't forget our seventh characters are coding for a because this e is indeed the initial encounter now what is the difference between B and D right away I can see that the fourth characters are different one is coding with for a three and another zero so I want to go over to the codes and see what the difference really means so T 2 1.3 is third degree of trunk right and some people and don't be afraid to ask some people might say well what is your trunk well this whole subcategory is coding for the whole well parts of the trunk the trunk that are codable and if you look look at T2 1.31 your chest wall is a part of the trunk a specific part of the trunk the abdominal wall is a specific part so two is the upper back the lower back the buttock yes the male genital region and more just to give you an idea that this is all your trunk all right now did I put it that way if you look at T2 1.30 this is the code for burn of third degree of the trunk unspecified and if you look at the documentation we just have Burns to his back was this specified huh all right so let's look at T to 1.33 XA t21.33 is burn of the upper back and there's no mention of where on the back this patient was burned and they give you a little bit of information about upper back it says burn a third degree of interscapular region you know what we're not up therefore we don't know where on the back so I like the unspecified code T2 1.30 x a burn of the trunk unspecified now this is third degree so we've got our answer it's D again now let's do our due diligence and finish coding it out and just so you know if you didn't have if you had to code this on your own you do have instructional notes that kind of help you too and it tells you use an additional external cost code to identify the source and the place and intent of the burn so let's code all of the burns and then let's go ahead and code our external causes all right so if you look at the next code t24.209 a we can deduce that this is the burn to the leg the second degree burned to the leg T2 4.209 burn of second degree of unspecified site of unspecified lower limb except ankle and foot and this is correct and the seventh character extender is a and that two is correct now let's get to the good stuff this pbsa or ebsa T3 1.31 and the purpose of this is just to kind of look at the codes T3 1.3 Burns involving 30 to 39 of the surf body surface right and we do fall in that we're 30. now they want you to be even more specific right we selected 0.31 because it answers the depth or the third degree portion because this green language wants you to identify the third degree it's the most significant so they want to know of your body the total body surface how much was third degree and ours is 11 and 11 Falls right Within this number 10 to 19 percent so you see it's 11 so t31.31 is our answer and we're going to finish things off with our extent or external causes codes X zero eight one subcategory exposure to sofa fire and then when you go to 1 1 exposure to sulfifier due to a burning cigarette man this tells the whole story how it happened when it happened not why it happened well why it happened not when it happened all right so if you got this correct and you said d outstanding way to go all right so I see some aha moments in the chat that's what I'm talking about someone said I understand someone said aha all right good good and and also too people say hey I see that upper back I didn't realize they separated the codes out yeah they do outstanding aha moment all right so you want to try another scenario okay now this one might not be realistic but will work we'll work with it okay what are the icd-10-cm codes for this encounter a t21.31 XA T2 1.21 XA T2 1.11 x a T3 1.33 w38.xx a y ninety nine two point zero zero zero B T2 1.31 XA t21.21 XA t21.11 XA t31.33 x a w 3x point x x x x a y 9 2.000 c t 2 1.30 x a T2 T3 1.33 w38 point x x x a y 92.000 and d t three one T2 1.31 XA T2 1.33 XA T2 1.34 x a t31.33 w38 XXX a and Y 9 2.000 while in the kitchen cooking spinach in her pressure cooker the cover dislodged and the steam from the cooker caused Mary to sustain second first degree four percent second degree and excuse me two percent first degree four percent second degree and thirty percent third degree burns to her trunk area for a total of 36 area burned what are the icd-10-cm codes for this encounter and if you don't think that the longer it is the longer it is you may have an aha moment it doesn't mean the longest is wrong but it does mean that those long scenarios can give you a lot of wrong stuff I digress your time continues all right so you all probably could have gotten this really quickly all right let me see how you're doing I'm gonna undock my chat that's right someone said they remembered the longer the longer you guys rock majority of you got this correct and if you didn't don't feel bad you're gonna have an aha moment all right I'm going to highlight my key terms kitchen cooking she had a two percent one first degree four percent second degree and thirty percent third degree burns to her trunk I'm like is this woman rolling around in it so I apologize if I created this scenario because it's not realistic all right so the guideline that applies is when you have multiple green degree burns of the same anatomic site you're supposed to code the highest degree right so we had first second and third degree in the same anatomic site so we are only going to code the third degree everybody with me all right so we're going to start with the first code T2 1.31 and t21.30 all three of the answers a b and d are the same T2 1.31 and C is T2 1.30 so if we go to our code our subcategory T2 1.3 this is the code for burn of third degree of the trunk and T2 1.30 is the code for unspecified site so C is coding for unspecified site and the others are coding for the chest wall there is no mention of the chest wall no so a B and D are all wrong and I know you said Mrs yeah I know you didn't go out like that but you know what a lot of these codes you do go out like that but let's go ahead and let's do our due diligence now if if Mary sustained 36 Burns to her trunk area then her entire chest was burned and her back was were burned and look how they're dividing up the the chest and the back in the previous image it was 18 on the front 18 on the back but here we have nine percent upper chest nine percent lower um nine percent upper back nine percent lower upper in upper chest nine percent Plus the lower chest nine percent upper back and lower back all 36 of her body was burned so as I said with the pressure cooker she was must have been rolling get me in the front get me in the back I don't know but I apologize because it doesn't make sense but nonetheless let's go ahead and code this out so let's take a look at the total body surface area or the extent of the body surface area t31.33 so that code should be coding for 36 percent of the tbsa or ebsa so let's go to 2t31 category these are burns classified to the ebsa extent of body surface involved and then we're going to go down to 3 3 T3 1.33 this is Burns involving 30 to 39 of the body surface with 30 to 39 percent of those Burns being third degree and that is our case she had 30 percent third degree and this code is accurate now our guidelines tell us that after you burn code for the burns and the tbsa you need to code the extent or the external causes to tell the story now we've got a w38.xxa and this is the code for explosion and rupture of other specified pressurized devices this is indeed what happened we had a pressure cooker it is a seventh character um um extender we have a seventh character extender requirement and see that X the excess you have to elongate it and x marks the spot so we're going to put three X's to make this w38 long so it can be seven characters we're going to add the seventh character extender and there you go three w three eight point x x x a in our final activity code y92.000 tells you the place of a of a current so y92 0.00 is unspecified non-institutional private residence as the place of Inc of external cause specifically the kitchen of unspecified non-institutional private residents of the place of incurrence of external causes and C is the best of the four answers and if you said CE like a lot of you did outstanding and if you had an aha moment that is priceless thank you for attending this class snippet brought to you by AMCI until next time