# ICD-10 Burn Coding



## karen57

Some of us at work were doing one of the ICD-10 refresher webinars offered by AAPC.  We were doing the sepsis webinar and disagreed with AAPC about the answer in one of the examples; I e-mailed AAPC, but I thought I'd see what you guys think.

Example:  A consultation is requested for a patient with third degree burns to his entire back that has developed sepsis.

Our answer:
T21.33XA for the 3rd degree burn of the upper back
T21.34XA to account for the 3rd degree burn of the lower back
T31.11 to account for the percentage 
A41.9 for the sepsis

AAPC's answer was T21.33XA for the burn, and the rest the same.

Our issue is with the burn code.  Since the example specified the entire back and there is no code for the entire back, would we not need both codes?  The index in ICD-10 -- at least, in my copy, which is the AAPC book -- does have a code for burns to "back (lower)", but that defaults to the lower back code, which again differs from the correct answer in the webinar.

Opinions?

Thanks!


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## em2177

ICD-10 makes a distinction between burns and corrosions. In addition to the distinction, there are coding conventions that are essential in attaining the correct code assignment. These conventions include:

*Sequencing*
When more than one burn/corrosion is present, sequence the code that reflects the highest degree first.
When the reason for the admission or encounter is for treatment of external burns/corrosions, sequence the code
that reflects the highest degree first.
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.

*Burns/corrosions of the same local site*
Classify burns of the same local site, but of different degrees, to the subcategory identifying the highest degree recorded in the diagnosis.

*Non-healing and infected burns/corrosions*
Non-healing and necrosis (death) of burned skin should be coded as acute burns. For any infected burn site, use an additional code for the infection.

*Assign separate codes for each burn site*
When coding burns, assign separate codes for each burn site. Category T30, ?Burn and corrosion, body region unspecified,? is extremely vague and should rarely be used.


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## karen57

Thanks for the great information!  What are your thoughts about the coding of the third-degree burn to the entire back?  Should we use T21.33xA and T21.34xA to account for both upper and lower back, or would it be more correct to use just T21.33xA for just the upper back, as was done in the webinar scenario?  I e-mailed AAPC for clarification but haven't received a response yet.

Thanks!


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## mitchellde

Karen I would do it the way you indicate with both codes because they are clearly two different parts of the same area.  If this were hand and you had 3rd degree of say Palm and back of hand you would either both areas or multiple sites of hand, however there is no multiple sites of the back as a choice only upper and lower so if the documentation stated entire back I would agree that both codes are necessary.


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## em2177

Since there is a distinction between upper and lower back, I would use both codes.


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