Every minute, someone in the United States experiences a burn injury requiring medical attention. With approximately 486,000 annual hospital admissions and emergency department visits for burn treatment, proficiency in Burn Care Coding Guidelines is crucial for medical coders. This guide provides essential information to accurately code burn cases, ensuring proper reimbursement and data collection.
Understanding Burn Types and Corrosions
Burns are defined as tissue damage resulting from heat, chemicals, electricity, sunlight, or radiation, leading to partial or complete skin destruction. It’s important to distinguish between burns and corrosions in ICD-10 coding:
- Burns: These codes are specifically for thermal burns (excluding sunburns) caused by heat sources such as fire, hot appliances, electricity, and radiation.
- Corrosions: These codes are designated for burns caused by chemical substances.
This distinction is vital for selecting the correct ICD-10 codes.
Degrees of Burn Severity
The severity of a burn is classified by its depth of tissue damage. Understanding burn degrees is fundamental for accurate burn care coding guidelines. There are several classifications, but we will focus on the most commonly used:
- First-degree burns: These are superficial burns affecting the epidermis, the outer layer of skin. They are characterized by erythema (redness).
- Second-degree burns: These burns are partial-thickness burns that damage the epidermis and extend into the dermis, the layer beneath. Blistering is a hallmark of second-degree burns.
- Third-degree burns: These are full-thickness burns involving complete tissue loss, destroying both the epidermis and dermis, and potentially affecting underlying tissues like hair follicles, oil glands, and sweat glands.
Accurate identification of burn degree is essential for the first-listed diagnosis code in burn care coding guidelines.
ICD-10 Coding: Applying the Rule of Nines
Properly reporting burn diagnoses in ICD-10 requires a minimum of three codes to capture the site, severity, and extent of the burn, along with the external cause. The “Rule of Nines” is critical for determining the extent of the burn.
First-Listed Code(s): Site and Severity (Categories T20-T25)
The initial code in burn care coding guidelines is a combination code from categories T20-T25, specifying both the anatomical site and the severity of the burn or corrosion.
- Categories T20-T28 are organized by body location affected by the burn or corrosion.
- The fourth character indicates the burn severity (except for categories T26-T28). Degrees of burns (first, second, third) determine this character.
- The fifth character provides further detail about the specific anatomical site.
- The sixth character specifies laterality (left or right side of the body, if applicable).
Next Listed Code: Extent of Burn (Categories T31/32)
Following the site and severity codes, burn care coding guidelines require a code to represent the extent of the burn, or the Total Body Surface Area (TBSA) involved.
- Code T31 is used for burns, and T32 is used for corrosions.
- These codes are based on the “Rule of Nines,” a method to estimate TBSA in adults.
- In adults, the Rule of Nines assigns 9% TBSA to the head, each arm, the front and back of the trunk, and each leg (18% per leg), with 1% assigned to the genitalia.
- A modified Rule of Nines is used for infants and children to account for different body proportions, with a larger percentage for the head and smaller percentages for the legs.
- The fourth character in T31/T32 codes indicates the total percentage of body surface area affected by burns.
- The fifth character specifies the percentage of TBSA with third-degree burns only.
Lastly, External Cause Code(s)
The final component of burn care coding guidelines in ICD-10 is to include external cause codes to provide context for the burn.
- External Cause Codes: These codes identify the source or cause of the burn, the location where it occurred, and the intent (accidental, intentional, etc.).
- Agent Codes: For corrosions, agent codes specify the chemical substance that caused the burn.
While ICD-10-CM guidelines recommend including external cause codes for burn patients, it’s important to note that payer acceptance of these codes can vary.
CPT Coding and the Lund-Browder Chart
CPT codes for local burn treatment and skin grafting procedures often specify the TBSA treated. CPT® utilizes the Lund-Browder classification, a more precise method than the Rule of Nines, for calculating TBSA for burns and grafts, especially in pediatric cases.
The Lund-Browder chart divides the body into 19 areas and uses different percentages for six age groups, acknowledging changes in body proportions from infancy to adulthood. This detailed approach ensures greater accuracy in calculating burn extent for CPT coding.
The CPT® code book includes the Lund-Browder classification method chart to facilitate TBSA calculation based on body area and patient age, providing a valuable tool for precise burn care coding guidelines application in procedural coding.
By understanding these burn care coding guidelines for both ICD-10 and CPT coding systems, medical coders can accurately and comprehensively report burn cases, ensuring appropriate medical documentation and reimbursement.
