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BURN Guidelines

Definition of Burn

  • The burn is tissue damage with the partial or complete destruction of the skin caused by heat, chemicals, electricity, sunlight, or nuclear radiation. 
  • Scalds from hot liquids and steam, building fires, and flammable liquids and gases are the most common causes of burns. Inhalation injury, another type of burn, results from breathing smoke.

Burn Types

  • Thermal burns are caused by an external heat source such as fire or hot liquids in direct contact with the skin, causing tissue cell death or charring.
  • Electrical burns happen when the body makes contact with an electric current. Electrical burns can be more extensive than what is seen externally, often affecting internal tissues and muscles.
  • Radiation dermatitis is a type of dermatitis resulting from exposure of the skin, eyes, or internal organs to types of radiation. Causes include exposure from sources such as Cobalt therapy, fluoroscopy, welding arcs, sun exposure, and tanning bed lights.
  • Corrosion's are chemical burns due to contact with internal or external body parts caused by strong acids such as bleach and battery fluid, or strong bases (alkalis) such as ammonia, detergents, or solvents.

Degrees of Burns

Burn severity is classified based on the depth of the burn. There are six degrees of burns,
  • First-degree burns damage the outer layer (epidermis) of the skin. These burns are usually dry, red (erythematous), and painful and usually heal on their own within a week. A common example is a sunburn.
  • Second-degree burns indicate blistering with damage extending beyond the epidermis partially into the layer beneath it (dermis). When severe, these burns might necessitate a skin graft — natural or artificial skin to cover and protect the body while it heals — and they may leave a scar
  • Third-degree burns indicate full-thickness tissue loss with damage or complete destruction of both layers of skin (including hair follicles, oil glands, and sweat glands). These burns always require skin grafts
  • Fourth-degree burns extend into fat.
  • Fifth-degree burns extend into the muscle
  • Sixth-degree burns extend damage down to the bone
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, 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.
  • When a patient has both internal and external burns/corrosion's, the circumstances of admission govern the selection of the principal diagnosis (i.e., first-listed diagnosis).
  • 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 diagnosis.

Code Using the Rule of Nines

ICD-10 burn codes are reported by body location, depth, extent, and external cause, including the agent or cause of the corrosion, as well as laterality and encounter. To code burn cases correctly, specify the site, severity, extent, and external cause.

You need at least three codes to properly report burn diagnoses,

First-listed code(s): Site and severity (from categories T20-T25)

  • Your first-listed code will be a combination code that reports both the site and severity of the injury. The site refers to the anatomical location that is affected by the burn or corrosion. 
  • Code descriptions in the T20-T28 range first define a general part or section of the human body.
  • The fourth character for each category identifies the severity (except categories T26-T28). 
  • Using the layers of the skin, the severity of a burn is identified by degree.
  • The fifth character enables you to report additional details regarding the anatomical site of the burn.
  • The sixth character represents laterality.

Next-listed code: Extent (from code category T31/T32)

  • Burns and corrosions are classified according to the extent or percentage of the body surface involved.
  • Total body surface area (TBSA) involved is reported using a code from T31 for a burn or T32 for corrosion, based on the classic “rule of nines,”.
  • The rule of nines for adult patients assigns 1 percent of TBSA to the genitalia and multiples of 9 percent to other body areas (9 percent for the head, 9 percent per arm, 18 percent per leg, etc.).
  • A modified rule of nines is applied for infants to account for their relatively larger head (18 percent) and smaller legs (14 percent, each).
  • The required fourth character identifies the percentage of the patient’s entire body affected by burns.
  • The fifth character identifies the percentage of the patient’s body suffering from third-degree burns or corrosion's only.

Additional code(s): External cause code(s)

  • ICD-10-CM guidelines recommend reporting appropriate external cause codes for burn patients. Not all payers accept these codes, however.
  • External cause – To identify the source, place, and intent of the burn.
  • Agent – To identify the chemical substance of the corrosion.
  • Determining a CPT code for burn treatment requires documentation of the degree of the burn and the percentage of body area affected. Documenting what is done during the visit is important because burn coding can be used for a dressing change or debridement.

Note: 

  • Burn treatment codes can be used in addition to an office visit; however, the office visit must be medically necessary and modifier 25 Significant, separately identifiable evaluation and management service by the same physician other qualified health care professional on the same day of the procedure or other service must be appended to the office visit. 
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