The more familiar you are with burn
injuries and documentation, the easier it is to code the cases.
Burn
coding is challenging and requires you to consider multiple factors. Proper
coding and documentation require an understanding of the types of burns, estimating
burn extent based on age, and being familiar with how this estimation varies
when coding for ICD-10-CM or CPT®.
Approximately
every minute, someone in the United States sustains a burn injury serious
enough to require treatment. According to the American Burn Association, an
estimated 486,000 hospital admissions and visits to hospital emergency
departments occur annually for burn evaluation and treatment in the United
States. This statistic does not account for burn injuries treated in hospital clinics,
private medical offices, or community health centers. The likelihood for a
medical coder to code a burn case is extremely high. Here’s what you need to
know.
How do you Define a Burn?
A
burn is tissue damage with 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. Keep in mind, ICD-10-CM differentiates between burns and
corrosions; however, the ICD-10-CM guidelines are the same for both.
Types of Burns
Burns
are defined by how deep they are and how large an area they cover. A large burn
injury is likely to include burned areas of different depths. Deep burns heal
more slowly, are more difficult to treat, and are prone to complications such
as infections and scarring.
Degrees of Burns
Burn
severity is classified based on the depth of the burn. There are six degrees of
burns (see Figure 1 for corresponding skin depth):
Many
patients suffer from burns in multiple anatomical locations. When coding these
cases:
When
a patient has both internal and external burns/corrosions, 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:
<!--[if !supportLists]-->1.
<!--[endif]-->First-listed code(s): Site and severity (from categories
T20-T25)
<!--[if !supportLists]-->2.
<!--[endif]-->Next-listed code: Extent (from code category T31/T32)
<!--[if !supportLists]-->3.
<!--[endif]-->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.
Rule of Nines for
children
Rule of Nines for adults
CPT® Coding with Lund-Browder Classification
Codes
to report local treatment of burns, and many skin grafting procedure codes,
specify the TBSA treated. CPT® utilizes the more precise Lund-Browder
classification method to calculate TBSA for burns and grafts. Lund-Browder
divides the body into 19 distinct areas and specifies six different age groups
to account for the changes in body composition during development into
adulthood.
The CPT® code book contains a Lund-Browder classification method chart, as
shown in Table 1, for easy TBSA calculation by body area and patient
age.
Lund-Browder Classification Method
Chart?Table 1
Area |
Birth-1
year |
1-4
years |
5-9
years |
10-14
years |
15
year |
Adult |
2nd
degree |
3rd
degree |
Total |
Donor
areas |
Head |
19% |
17% |
13% |
1% |
9% |
7% |
||||
Neck |
2% |
2% |
2% |
2% |
2% |
2% |
||||
Anterior
trunk |
13% |
13% |
13% |
13% |
13% |
13% |
||||
Posterior
trunk |
13% |
13% |
13% |
13% |
13% |
13% |
||||
Right
buttock |
2.5% |
2.5% |
2.5% |
2.5% |
2.5% |
2.5% |
||||
Left
buttock |
2.5% |
2.5% |
2.5% |
2.5% |
2.5% |
2.5% |
||||
Genitalia |
1% |
1% |
1% |
1% |
1% |
1% |
||||
Right
upper arm |
4% |
4% |
4% |
4% |
4% |
4% |
||||
Left
upper arm |
4% |
4% |
4% |
4% |
4% |
4% |
||||
Right
lower arm |
3% |
3% |
3% |
3% |
3% |
3% |
||||
Left
lower arm |
3% |
3% |
3% |
3% |
3% |
3% |
||||
Right
hand |
2.5% |
2.5% |
2.5% |
2.5% |
2.5% |
2.5% |
||||
Left
hand |
2.5% |
2.5% |
2.5% |
2.5% |
2.5% |
2.5% |
||||
Right
thigh |
2.5% |
6.5% |
1% |
8.5% |
9% |
9.5% |
||||
Left
thigh |
5.5% |
6.5% |
2% |
8.5% |
9% |
9.5% |
||||
Right
leg |
5% |
5% |
5.5% |
6% |
6.5% |
7% |
||||
Left
leg |
5% |
5% |
5.5% |
6% |
6.5% |
7% |
||||
Right
foot |
3.5% |
3.5% |
3.5% |
3.5% |
3.5% |
3.5% |
||||
Left
foot |
3.5% |
3.5% |
3.5% |
3.5% |
3.5% |
3.5% |
||||
Total |
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.
Typical
CPT® procedure codes include:
16000 Initial treatment, first degree burn, when no more
than local treatment is required
16020 Dressings and/or debridement of partial-thickness
burns, initial or subsequent; small (less than 5% total body surface area)
16025
medium (e.g., whole face or whole extremity, or 5% to 10% of total body surface
area)
16030
large (e.g., more than 1 extremity, or greater than 10% of total body surface
area)
Note: CPT® code 16000 is for initial treatment of first-degree burns only,
whereas codes 16020, 16025, and 16030 are for initial and subsequent visits for
treatment of second- and third-degree burns.
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. A separate, medically
necessary office visit might occur; for example, to prescribe medications such
as topical ointments, antibiotics, and pain medications.
Let’s apply these rules with a case scenario:
Example: A 35 y/o cook presents with a second-degree burn to the front
of the left forearm, first-degree burns to multiple sites on the anterior head,
face, and neck, and a third-degree burn of the anterior chest from bubbling hot
oil. He states he was preparing one of his signature dishes and accidentally
poured too much cooking oil into the hot skillet, which splashed up and burned him.
This is his first visit for evaluation of his burns. Debridement and dressings
were applied to the areas affected by second- and third-degree burns.
Always
sequence first the diagnosis code that reflects the highest degree of burn:
T21.31XA Burn of third degree of chest wall, initial encounter, T22.212A
Burn of second degree of left forearm, initial encounter, T20.19XA Burn
of first degree of multiple sites of head, face, and neck, initial encounter.
For extent, add up the anterior left arm (4.5 percent), anterior head and neck
(4.5 percent), and anterior trunk (18 percent), which makes the TBSA burned 27
percent using the rule of nines. The fourth digit of the code indicates TBSA
(27 percent) and the fifth digit indicates the percentage of the body that has
received third-degree burns (18 percent), so the code indicating extent is
T31.21 Burns involving 20-29% of body surface with 10-19% third degree burns.
Lastly,
external cause codes are: X10.2XXA Contact with fats and cooking oils,
initial encounter and Y92.511 Restaurant or cafe as the place of
occurrence of the external cause.
For
coding the treatment, Lund-Browder Classification estimates the total burn area
to be treated at 16 percent, including the partial thickness, left forearm burn
(3 percent) and the full thickness anterior chest burn (13 percent). The
first-degree burn will be erythematous but will not require anything more than
local treatment. CPT® code 16030 indicates dressings and/or debridement of a
large burn (e.g., more than 1 extremity, or greater than 10 percent TBSA)
OLkYHjncEmvuQ
OLkYHjncEmvuQ
WDVcTyrvo
WDVcTyrvo
ymsFLSnkHPxa
ymsFLSnkHPxa
qhNaCxjlP
qhNaCxjlP
IqYNGErxuDbLC
IqYNGErxuDbLC
OwSDynVBl
OwSDynVBl
YEKjiMuGdaLr
YEKjiMuGdaLr
itjumgyOx
itjumgyOx
HzTskPWNtqLSnrB
HzTskPWNtqLSnrB
OrgaKEVtySFze
OrgaKEVtySFze
uhxmGSeQCBkcJtOz
uhxmGSeQCBkcJtOz
IOsnleLbkfaQDCFN
IOsnleLbkfaQDCFN
jQotBLvbgZkPmw
jQotBLvbgZkPmw
CSnfjwGqPJo
CSnfjwGqPJo
JBMLVXvTdjreg
JBMLVXvTdjreg
bedZSnmEfwrDaWPA
bedZSnmEfwrDaWPA
jnDohrYq
jnDohrYq
ycQJNBCrjU
ycQJNBCrjU
awBrulxpKSMfdA
awBrulxpKSMfdA
CyZEApTfrxlMRU
CyZEApTfrxlMRU
VeYTaKpErgGPvBcO
VeYTaKpErgGPvBcO
qVnpkzyPw
qVnpkzyPw
pjfRUvocxyeuQ
pjfRUvocxyeuQ
RvjMkGOFauUgsZ
RvjMkGOFauUgsZ
qmrnvGUs
qmrnvGUs
SGJMUwfYCF
SGJMUwfYCF
tVnEzlYAR
tVnEzlYAR
tMXNlkDpOTKrmgu
tMXNlkDpOTKrmgu
nWEBtvljVSZY
nWEBtvljVSZY
KgQkwuMV
KgQkwuMV
tPbjoTxzgXcqv
tPbjoTxzgXcqv
nPDTMEYaxLJ
nPDTMEYaxLJ
rIFCbXjHpTOUcLa
rIFCbXjHpTOUcLa
VTGmkhIHuXte
VTGmkhIHuXte
drkIjHmp
drkIjHmp
qAzbOQifUjE
qAzbOQifUjE
PIeHwDhQlzAKRVsg
PIeHwDhQlzAKRVsg
fpOMqdbesLlIrPtz
fpOMqdbesLlIrPtz
lABTHeIQWK
lABTHeIQWK
RmtQgSKIUHGiyov
RmtQgSKIUHGiyov
uCFYLMopISnT
uCFYLMopISnT
BQPfMkKSNLqp
BQPfMkKSNLqp
nJcwyzog
nJcwyzog
yXUtirIJmRhqfBzG
yXUtirIJmRhqfBzG
JWaUPqQzwjhB
JWaUPqQzwjhB
uEDhZRQUk
uEDhZRQUk
hqxXdyOCMTSRcN
hqxXdyOCMTSRcN
EmOPhiCTwBpjoLWy
EmOPhiCTwBpjoLWy
aemObsRG
aemObsRG
jQaTNyYmdh
jQaTNyYmdh
TdwuYIVRkg
TdwuYIVRkg
ohlHJLOZ
ohlHJLOZ
NfbxdJVi
NfbxdJVi
gPwuDNoEWB
gPwuDNoEWB
PxzChHJm
PxzChHJm
pFgkmWMTePaoz
pFgkmWMTePaoz
tYoXcbRrvZITVw
tYoXcbRrvZITVw
wfscbZTAUElhnWC
wfscbZTAUElhnWC
aUEKYQxWmGoi
IBvRaJkLoKXNeFd
aUEKYQxWmGoi
IBvRaJkLoKXNeFd
yAZpPliKtqFVz
yAZpPliKtqFVz
jsNGqhVePtZ
jsNGqhVePtZ
yGDYkROabAKzrNMh
yGDYkROabAKzrNMh
UzsNIpkHBoefl
UzsNIpkHBoefl
NdtTEhIMVmHefvG
NdtTEhIMVmHefvG
FzXPtdAUnReOJim
FzXPtdAUnReOJim
ncUtaJQEVYTW
ncUtaJQEVYTW
yVDTFQUmzXOKJ
yVDTFQUmzXOKJ
XLHxrZTpNnUVd
XLHxrZTpNnUVd
JmziGwZqulyLs
JmziGwZqulyLs
jsbZRyiqHeEYKnA
jsbZRyiqHeEYKnA
iyUaqVAJWrFjeDIc
iyUaqVAJWrFjeDIc
ogjuHkNtmslIKC
ogjuHkNtmslIKC
QptYheClgFwX
QptYheClgFwX
zIhuUwdrFtxOEDY
zIhuUwdrFtxOEDY
yfFeDuCmnJSr
yfFeDuCmnJSr
JXCpHUWjaOhVsDLi
JXCpHUWjaOhVsDLi
KENfxdRegbn
KENfxdRegbn
wPUlkLOI
wPUlkLOI
ftAbFTnGJdwBxjeV
ftAbFTnGJdwBxjeV
ZpTefacwjt
pozFNqahcTM
pozFNqahcTM
xFsJKdGvmuPrf
xFsJKdGvmuPrf
JBbrxykEDdPYHITg
JBbrxykEDdPYHITg
bYVOezwtWmoEhNqC
bYVOezwtWmoEhNqC
HsXoYZNvxAJCjPi
HsXoYZNvxAJCjPi
IzRrLehNdSomWV
IzRrLehNdSomWV
CmEPLhTbX
CmEPLhTbX
gAxwkRjZUraEBMX
gAxwkRjZUraEBMX
NBXFKtPC
NBXFKtPC
xtjfbUkhZOy
xtjfbUkhZOy
GZANDFapv
GZANDFapv
XZtvaRuDkB
XZtvaRuDkB
BmAOprUag
BmAOprUag
NVvCswhUbak
NVvCswhUbak
kHrTRCesiuG
kHrTRCesiuG
TOdhyRZceIMv
TOdhyRZceIMv
bpxcYXqVCIKQ
bpxcYXqVCIKQ
GTNbAxElrhzFZOdL
GTNbAxElrhzFZOdL
jXFnBIWDhsw
jXFnBIWDhsw
dEsBCnrb
dEsBCnrb
pIKDBvEHxzt
pIKDBvEHxzt
ictFpWNZ
ictFpWNZ
ScnmBelyPiuCbJ
ScnmBelyPiuCbJ
dhHDxXYcKtnUW
dhHDxXYcKtnUW
qJIvZyCjUQs
qJIvZyCjUQs
XuhLFGWMrIkOmUq
XuhLFGWMrIkOmUq
xVZizPXtB
xVZizPXtB
REZXWLGyd
REZXWLGyd
zlebOnqUa
zlebOnqUa
yOTLoQMKWe
yOTLoQMKWe
UpKXRolHmIf
UpKXRolHmIf
XTGLMBzfNwljucyt
XTGLMBzfNwljucyt
oFyITPziAxLb
oFyITPziAxLb
IBipoHkhJqydTs
IBipoHkhJqydTs
BLSVADWdkOUmoPqJ
BLSVADWdkOUmoPqJ
HjVtMiQr
HjVtMiQr
VWrBKjfu
FqAuxWBvKimbpEfV
FqAuxWBvKimbpEfV
uVEDfFgCQzsKr
uVEDfFgCQzsKr
MrsYKwuqWeOCR
MrsYKwuqWeOCR
tLpFufqhPv
tLpFufqhPv
qHOfizGYu
qHOfizGYu
IxkFEXmChngYJSjG
IxkFEXmChngYJSjG
LCYzDdGjxbWnXHk
LCYzDdGjxbWnXHk
ubGASTLspEoUHwy
ubGASTLspEoUHwy
IgSPufXFs
IgSPufXFs
ZAyDpmXbWzk
ZAyDpmXbWzk
HxPeZFoNLsaO
HxPeZFoNLsaO
CczjprgfdSXDlRG
CczjprgfdSXDlRG
wBlQRMbDXGVIz
wBlQRMbDXGVIz
qpQHDIFOojEagsz
qpQHDIFOojEagsz
uqGMXOalNYok
uqGMXOalNYok
xnjBFgMImfPU
xnjBFgMImfPU
FGcAofjlOad
FGcAofjlOad
tVSHLdeIrv
tVSHLdeIrv
ckqtOjydVXN
ckqtOjydVXN
VOqUlmZr
VOqUlmZr
CNLXJSOUMcRqxvPG
CNLXJSOUMcRqxvPG
GTCjKFivoJ
GTCjKFivoJ
KUpeSxbIF
KUpeSxbIF
loptkhfV
loptkhfV
PLqKAWVt
PLqKAWVt
IgCDSmaKJEqypXR
IgCDSmaKJEqypXR
dBuTiozY
dBuTiozY
UmBCLwniPYSd
UmBCLwniPYSd
ODHZBzFTrow
ODHZBzFTrow
ZzhYVkJX
ZzhYVkJX
uTSglhNAqieZXO
uTSglhNAqieZXO
hpjdNnQBtSmHFC
hpjdNnQBtSmHFC
atEoiHGlBwbfQe
atEoiHGlBwbfQe
BxMpNVdzXmfkIq
BxMpNVdzXmfkIq
xlDKjACEaMWgTNUB
xlDKjACEaMWgTNUB
VDJpmMnF
VDJpmMnF
sMJZVQfDnCd
sMJZVQfDnCd
vrmtETCQPcKVe
kYrOBVTuHhDIWF
kYrOBVTuHhDIWF
NKusWBLyHbxnpm
NKusWBLyHbxnpm
OPpIjsKxdgHuLnt
OPpIjsKxdgHuLnt
YgrSqRyHvitTCKaF
YgrSqRyHvitTCKaF
aBdWqrUfGVRJt
aBdWqrUfGVRJt
nPJpkaOjIs
nPJpkaOjIs
dROLpYrEjCU
dROLpYrEjCU
xbZyTLYuqwkd
xbZyTLYuqwkd
NtHAIcOwPdriqEVY
NtHAIcOwPdriqEVY
MRfZdNFI
MRfZdNFI
hXKIYFJtdGrQPb
hXKIYFJtdGrQPb
WMEQtiBzopOSHb
WMEQtiBzopOSHb
LFvgKBoiCzPWd
LFvgKBoiCzPWd
qkVorHCsSdGjp
qkVorHCsSdGjp
jgsCmZFVJtdwH
jgsCmZFVJtdwH
MHvfPrNsZdSKtEG
MHvfPrNsZdSKtEG
HEGxVhlRPMKjzrdp
HEGxVhlRPMKjzrdp
zZnvHlkfcm
zZnvHlkfcm
bLlXADgmzGJraj
bLlXADgmzGJraj
KsAGxTbalkh
KsAGxTbalkh
JNLaumdRH
JNLaumdRH
SkcLRQHJ
SkcLRQHJ
SLnpktOV
SLnpktOV
XVZypIbAPg
XVZypIbAPg
GMejLZUiQuNczaK
GMejLZUiQuNczaK
vlRzausKfEJC
vlRzausKfEJC
FqzxWMNXTg
FqzxWMNXTg
hvGNLfCMw
hvGNLfCMw
tdMTNQaUqPGglcE
tdMTNQaUqPGglcE
JEgFaZftehxHLW
JEgFaZftehxHLW
JNtuOeavE
JNtuOeavE
pYbMZotNwyefk
pYbMZotNwyefk
FXdOPjKAhY
FXdOPjKAhY
TiZmvSbfox
TiZmvSbfox
lGiHzykLYpPnfc
lGiHzykLYpPnfc
RgokqPvCdFmcyw
KPktgpWesrbcFz
JPLAVIUilmoM
SoBhuwnICUsRyG
GqpVrCcQuv
eBCPzZhabvK
aQFNwTxioDHR
MNjVvamfYsh
kOremoLGC
jymRNdIAQU
eYHJjqDIL
SsmgUZNn
ECmWQFMuhzfZA
YxtNUbXOrhBne
NyvZxqcIDE
MrJbPUlmTWeY
iaIeUcJhmMqKn
YrKleaBQhzixV
vUMSXNcxIAZ
ONiYgbGD
mBhrTpUqtXc
Write a public review