Burns from a heat source are classified by depth (first, second, third, unspecified), extent, and agent. For multiple burns, sequence the highest degree burn first. Multiple burns of the same three-character category are coded to the highest degree. Non-healing burns are coded as acute burns.
The extent of injury is best described using the percentage of the total body surface area (%TBSA) that is affected by a burn. The measurement of burn surface area is important during the initial management of people with burns for estimating fluid requirements and determining need for transfer to a burns service
The rule of nines assesses the percentage of burn and is used to help guide treatment decisions including fluid resuscitation and becomes part of the guidelines to determine transfer to a burn unit. You can estimate the body surface area on an adult that has been burned by using multiples of 9
While only half the people with burns over 40 percent of their body survived in the 1940's, ''today, over 50 percent of all patients with burns involving 80 percent of total body-surface area survive,''
The ICD-10-CM makes a distinction between burns and corrosions. The burn codes are for thermal burns, except sunburns, that come from a heat source, such as a fire or hot appliance. You also report e burn codes when electricity or radiation caused the burn.
Corrosions are burns due to chemicals. The guidelines are the same for burns and corrosions.
Current burns (T20-T25) are classified by depth, extent ,and agent (X code). Burns are classified by depth as first degree (erythema), second degree (blistering), and third degree (full-thickness involvement). Burns of the eye and internal organs (T26-T28) are classified by site, but not by degree.
Coders also need to append the appropriate seventh character to specify the encounter when coding for burns and corrosions:
A, initial encounter
D, subsequent encounter
S, sequela
Be sure to check for code first and code additional notes. For example, a note under the code series T21.0 (burn of unspecified degree of trunk) instructs coders to use additional external cause code to identify the source, place and intent of the burn (X00-X19, X75-X77, X96-X98, Y92).
1st degree burn – Skin is red in appearance, scalding with hot sips of coffee, hot water, etc.
2nd degree burn – blisters form on the skin surface
3rd degree burn – Most severe – full thickness skin loss – sometimes extending even into the bone
Most severe burn goes first – 3, 2, 1 ---also, you can code only one degree of burn to one body area, like if 3rd, 2nd and 1st degree burns of the forearm are present, then you can only code the 3rd degree burn – forearm. But if different areas have multiple burns, you can go ahead and code all of them
Doctors have to give us the percentage of the burns – or you can query them
Rule of 9s is used in the burn classification. It helps to divide the body into multiples of 9
Guidelines for Classifying Burns
Unlike the ICD-9-CM code set, ICD-10-CM differentiates between burns and corrosions. ICD-10-CM burn codes describe thermal burns caused by a heat source, such as a fire, and burns resulting from electricity or radiation. ICD-10-CM corrosion codes describe burns caused by chemicals, such as battery acid. The ICD-10-CM guidelines are the same for both burns and corrosions, and mirror the burn guidelines in ICD-9-CM.
Burn severity is classified based on the depth of the burn:
· First degree = Erythema
· Second degree = Blistering
· Third degree = Full-thickness (epidermis and dermis)
Many patients suffer from burns in multiple anatomical locations. When coding these cases:
· Assign a separate code for each location with a burn.
· If a patient has multiple burns on the same anatomical site identified by a code, select the code that reflects the most severe burn for that location.
· Sequence the codes in order of severity, with the most severe burn listed first.
Example: A patient presents to the emergency department after being burned in a house fire. The emergency department physician’s documentation indicates the patient has first-, second-, and third-degree burns on his upper back, first- and second-degree burns on his left palm, and second- and third-degree burns on his left upper arm.
In ICD-10-CM, appropriate coding is:
T21.33XA Burn of third degree of upper back, initial encounter
T22.332A Burn of third degree of left upper arm, initial encounter
T23.252A Burn of second degree of left palm, initial encounter
Burns Classified According to Extent
Both ICD-9-CM and ICD-10-CM guidelines address coding burns classified according to the extent of body surface involved. In ICD-9-CM, the codes under 948 Burns classified according to extent of body surface involved are used. In ICD-10-CM, the codes under T31 Burns classified according to extent of body surface involved or T32 Corrosions classified according to extent of body surface involved are used.
Report these codes when the provider doesn’t specify the site of the patient’s burns in the medical record, or when there is a need for additional data. Burn units often accumulate this data to evaluate burn mortality. The guidelines also suggest using these codes when there is mention in the documentation of a third-degree burn involving 20 percent or more of the body surface area.
These codes are based on the classic “rule of nines” (as shown in the Rule
of Nines Burn Percentages figure) in estimating body surface involved. Body areas are measured in increments of 9 percent.
In ICD-9-CM, the fourth digit identifies the percentage of total body surface with all degrees of burns. The fifth digit identifies the percentage of the patient’s body surface with third-degree burns. Although a table of fifth digit options is not provided in ICD-10-CM, the codes follow the same general pattern as ICD-9-CM.
Be sure to check for code first and code additional notes. For example, a note under the code series T21.0 (burn of unspecified degree of trunk) instructs coders to use additional external cause code to identify the source, place and intent of the burn (X00-X19, X75-X77, X96-X98, Y92).
1st degree burn – Skin is red in appearance, scalding with hot sips of coffee, hot water, etc.
2nd degree burn – blisters form on the skin surface
3rd degree burn – Most severe – full thickness skin loss – sometimes extending even into the bone
Most severe burn goes first – 3, 2, 1 ---also, you can code only one degree of burn to one body area, like if 3rd, 2nd and 1st degree burns of the forearm are present, then you can only code the 3rd degree burn – forearm. But if different areas have multiple burns, you can go ahead and code all of them
Doctors have to give us the percentage of the burns – or you can query them
Rule of 9s is used in the burn classification. It helps to divide the body into multiples of 9
Guidelines for Classifying Burns
Unlike the ICD-9-CM code set, ICD-10-CM differentiates between burns and corrosions. ICD-10-CM burn codes describe thermal burns caused by a heat source, such as a fire, and burns resulting from electricity or radiation. ICD-10-CM corrosion codes describe burns caused by chemicals, such as battery acid. The ICD-10-CM guidelines are the same for both burns and corrosions, and mirror the burn guidelines in ICD-9-CM.
Burn severity is classified based on the depth of the burn:
· First degree = Erythema
· Second degree = Blistering
· Third degree = Full-thickness (epidermis and dermis)
Many patients suffer from burns in multiple anatomical locations. When coding these cases:
· Assign a separate code for each location with a burn.
· If a patient has multiple burns on the same anatomical site identified by a code, select the code that reflects the most severe burn for that location.
· Sequence the codes in order of severity, with the most severe burn listed first.
Example: A patient presents to the emergency department after being burned in a house fire. The emergency department physician’s documentation indicates the patient has first-, second-, and third-degree burns on his upper back, first- and second-degree burns on his left palm, and second- and third-degree burns on his left upper arm.
In ICD-10-CM, appropriate coding is:
T21.33XA Burn of third degree of upper back, initial encounter
T22.332A Burn of third degree of left upper arm, initial encounter
T23.252A Burn of second degree of left palm, initial encounter
Burns Classified According to Extent
Both ICD-9-CM and ICD-10-CM guidelines address coding burns classified according to the extent of body surface involved. In ICD-9-CM, the codes under 948 Burns classified according to extent of body surface involved are used. In ICD-10-CM, the codes under T31 Burns classified according to extent of body surface involved or T32 Corrosions classified according to extent of body surface involved are used.
Report these codes when the provider doesn’t specify the site of the patient’s burns in the medical record, or when there is a need for additional data. Burn units often accumulate this data to evaluate burn mortality. The guidelines also suggest using these codes when there is mention in the documentation of a third-degree burn involving 20 percent or more of the body surface area.
These codes are based on the classic “rule of nines” (as shown in the Rule
of Nines Burn Percentages figure) in estimating body surface involved. Body areas are measured in increments of 9 percent.
In ICD-9-CM, the fourth digit identifies the percentage of total body surface with all degrees of burns. The fifth digit identifies the percentage of the patient’s body surface with third-degree burns. Although a table of fifth digit options is not provided in ICD-10-CM, the codes follow the same general pattern as ICD-9-CM.
Example: A patient has burns on 75 percent of his body surface. Approximately 1/3 (33 percent) of his body surface has third-degree burns. In ICD-10-CM, appropriate coding is:
T31.73 Burns involving 70-79% of body surface with 30-39% third-degree burns
T31.73 Burns involving 70-79% of body surface with 30-39% third-degree burns
External Cause Codes
Both ICD-9-CM and ICD-10-CM guidelines recommend reporting appropriate
external cause codes for burn patients. Not all payers accept these codes, however.
Both ICD-9-CM and ICD-10-CM guidelines recommend reporting appropriate
external cause codes for burn patients. Not all payers accept these codes, however.
Example: A young man who was severely burned during an extensive, uncontrolled fire at the factory where he works was seen at the emergency room for evaluation. Investigators are unable to determine the cause of the fire.
Appropriate ICD-10-CM codes are:
X00.0XXA Exposure to flames in uncontrolled fire in building or structure, initial encounter
Y26.XXXA Exposure to smoke, fire and flames, undetermined intent, initial encounter
Y92.63 Factory as the place of occurrence of the external cause
Y99.0 Civilian activity done for income or pay
With the high volume of burns occurring on an annual basis, it’s important for you to understand the guidelines for coding these injuries. When documentation lacks the details necessary for you to code with the utmost specificity, query the provider.
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