This week's post comes from National Compliance and Quality Audit Manager, Sharon Nichols, BSBEB, RHIT, CCS, CHTS-TR.
Whether a beach vacation, backyard BBQ, or an accidental snooze in a local tanning salon is the cause of you turning as red as those lovely lobster dinners, (accompanied by the pain and misery of a flourishing sunburn that seems to gather heat as the evening progresses), ICD-10 has a code for it. Our summer coding trip into the realm of tanning beds and sunburns begins with some basic concepts to help us understand the types and degrees of burns. Remember…factor 50 is the key!!
Initially, we must understand the difference between burn types and degrees to fully grasp the coding concepts associated. The biggest difference from ICD-9-CM in this category of coding is the removal of overlapping thermal and chemical burn codes. With the detail provided in ICD-10-CM, the ability to completely code specific burns to type now exists as never before.
Types of burns:
- Thermal burns are caused by an external heat source such as fire or hot liquids in direct contact with the skin
- Corrosions are chemical burns in contact with internal or external body parts caused by strong acids such as bleach and battery fluid, or by strong bases (alkalis) such as ammonia or denture cleaner
- Radiation dermatitis is a type of dermatitis resulting from exposure to various types of radiation to the skin, internal organs or eyes and include exposure from sources such as Cobalt therapy, fluoroscopy, welding arcs, sun exposure and tanning bed lights
Degrees of burns:
- First degree burns indicate erythema and are limited to the outer layer of the epidermis
- Second degree burns indicate blistering with extension beyond the epidermis partially into the dermis (you needed MORE sunscreen if this happens)
- Third degree burns indicate a full-thickness tissue loss and can include tissue necrosis
But wait, sunburn is radiation dermatitis, not a thermal burn? That’s right, without sunscreen we’d all be toast, especially if you fall asleep on that beach towel. All snoozing aside, a short discussion of sunburn must include the basic science behind radiation from the sun. The sun emits different types of radiation:
- Electromagnetic (EM) is 99% visible light, think colors of the rainbow
- Infrared (IR) causes heat sensation, nice and warm
- Ultraviolet (UV) causes sunburn and eye damage
- Gamma rays are found in the core of the sun during fusion
- X-rays are emitted during solar flares
Ultraviolet radiation (UVA, UVB & UVC) is classified by wavelength and speed but UVC doesn’t reach earth due to the ozone. UVA and UVB do reach us with UVA being almost completely unfiltered which causes sunburn and eye damage i.e. photokeratitis. Because UV Radiation cannot be felt or seen, it is the most dangerous form of radiation from the sun. Sunburns are based on exposure to ultraviolet radiation and are coded to the L55 category with the 4th character as degree of severity.
Quick tip: welding/flash or arc burns are coded to photokeratitis i.e. radiation injury to the eye not caused by natural UV light rays. These corneal epithelial injuries are caused by exposure to bright flashes of artificial light including tanning beds, halogen desk lamps, lightening, and most often welding torches. Both natural and artificial photokeratitis code to the H16 category in chapter 7 of ICD-10 for disease of the eye.
Patient presents to ER with a second degree sunburn after an afternoon at the beach playing volleyball with friends on vacation.
- L55.1 – Sunburn of second degree
- X32.XXXA – Exposure to sunlight, initial encounter
- Y93.68 – Activity, volleyball
- Y92.832 - Beach as the place of occurrence
- Y998 – Other external cause status (leisure, hobby, recreation or sport activity not for income or while a student)
Tanning Bed Burns - Tanning Beds contain UVA and UVB light bulbs with typically more UVA than UVB bulbs to allow for more of a tan than a burn. Based on type of radiation and length of exposure, these codes fall into the L57 category for skin changes due to long-term exposure to solar and other forms of ultraviolet radiation such as tanning beds and are not coded based on degree of burn. When a patient has an acute burn from tanning bed exposure code L56.8 for Other specified acute skin changes due to ultraviolet radiation.
Patient presents to ER with second degree burns of the face, chest and buttocks due to tanning bed exposure. Triage record indicates patient stated she decided to stay in tanning bed longer than advised by local vendor which resulted in her burns. Patient had been going to salon for several weeks and decided it was time to increase her tanning time for improved results.
- L57.8 – Other skin changes due to chronic exposure to nonionizing radiation
- 189.1XXA – Exposure to tanning bed, initial encounter
- Y93.89 – Activity, other specified
- Y92.29 – Other specified public building as the place of occurrence
- Y99.8 - Other external cause status (leisure, hobby, recreation or sport activity not for income or while a student)
Well…now you know about the three burn types and degree, what radiation emits from the sun, and why a burn from the sun or tanning bed is not caused by thermal contact. We also shared why photokeratitis is another type of radiation injury that doesn’t fall into the thermal or corrosion classification. As we continue our summer coding trip we plan to bring you some interesting topics on those bizarre injuries we see in our Emergency Departments across the nation. I hope you enjoy the summer coding blog, see you again soon and remember SLIP, SLOP SLAP! Slip on a shirt, slop on sunscreen and slap on a hat!