When coding multiple injuries such as fracture of tibia and fibula, assign separate codes for each injury unless a combination code is provided, in which case the combination code is assigned. Multiple injury codes are provided in ICD-9-CM, but should not be assigned unless information for a more specific code is not available.

1. The code for the most serious injury, as determined by the physician, is sequenced first.
2. Superficial injuries such as abrasions or contusions are not coded when associated with more severe injuries of the same site.
3. When a primary injury results in minor damage to peripheral nerves or blood vessels, the primary injury is sequenced first with additional code(s) from categories 950-957, Injury to nerves and spinal cord, and/or 900-904, Injury to blood vessels. When the primary injury is to the blood vessels or nerves, that injury should be sequenced first.

The principle of multiple coding of injuries should be followed in coding multiple fractures. Multiple fractures of specified sites are coded individually by site in accordance with both the provisions within categories 800-829 and the level of detail furnished by medical record content. Combination categories for multiple fractures are provided for use when there is insufficient detail in the medical record (such as trauma cases transferred to another hospital), when the reporting form limits the number of codes that can be used in reporting pertinent clinical data, or when there is insufficient specificity at the fourth-digit or fifth-digit level. More specific guidelines are as follows:

1. Multiple fractures of same limb classifiable to the same three-digit or four-digit category are coded to that category.
2. Multiple unilateral or bilateral fractures of same bone(s) but classified to different fourth-digit subdivisions (bone part) within the same three-digit category are coded individually by site.
3. Multiple fracture categories 819 and 828 classify bilateral fractures of both upper limbs (819) and both lower limbs (828), but without any detail at the fourth-digit level other than open and closed type of fractures.
4. Multiple fractures are sequenced in accordance with the severity of the fracture and the physician should be asked to list the fracture diagnoses in the order of severity.

Current burns (940-948) are classified by depth, extent and, if desired, by agent (E code). By depth burns are classified as first degree (erythema), second degree (blistering), and third degree (full-thickness involvement).

1. All burns are coded with the highest degree of burn sequenced first.
2. Classify burns of the same local site (three-digit category level, (940-947) but of different degrees to the subcategory identifying the highest degree recorded in the diagnosis.
3. Non-healing burns are coded as acute burns. Necrosis of burned skin should be coded as a non-healed burn.
4. Assign code 958.3, Posttraumatic wound infection, not elsewhere classified, as an additional code for any documented infected burn site.
5. When coding multiple burns, assign separate codes for each burn site. Category 946 Burns of Multiple specified sites, should only be used if the location of the burns are not documented. Category 949, Burn, unspecified, is extremely vague and should rarely be used.
6. Assign codes from category 948, Burns classified according to extent of body surface involved, when the site of the burn is not specified or when there is a need for additional data. It is advisable to use category 948 as additional coding when needed to provide data for evaluating burn mortality, such as that needed by burn units. It is also advisable to use category 948 as an additional code for reporting purposes when there is mention of a third-degree burn involving 20 percent or more of the body surface. In assigning a code from category 948:

Fourth-digit codes are used to identify the percentage of total body surface involved in a burn (all degree).

Fifth-digits are assigned to identify the percentage of body surface involved in third-degree burn.

Fifth-digit zero (0) is assigned when less than 10 percent or when no body surface is involved in a third-degree burn.

Category 948 is based on the classic "rule of nines" in estimating body surface involved: head and neck are assigned nine percent, each arm nine percent, each leg 18 percent, the anterior trunk 18 percent, posterior trunk 18 percent, and genitalia one percent. Physicians 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.

7. Encounters for the treatment of the late effects of burns (i.e., scars or joint contractures) should be coded to the residual condition (sequelae) followed by the appropriate late effect code (906.5-906.9). A late effect E code may also be used, if desired.
8. When appropriate, both a sequelae with a late effect code, and a current burn code may be assigned on the same record.

1. For coding purposes, excisional debridement, 86.22, is assigned only when the procedure is performed by a physician.
2. For coding purposes, nonexcisional debridement performed by the physician or nonphysician health care professional is assigned to 86.28. Any "excisional" type procedure performed by a nonphysician is assigned to 86.28.