# excisional debridment of 3rd degree burn



## maxwell@marshall.edu (Nov 21, 2011)

these burns are getting the best of me.....

Procedure:
Debridement with biobrane to 200 cm2 of rt hand and wrist
excisional debridement with primary closure of 100 cm2 of 3rd degree burns to abdomen and back

after excellent level of general anesthesia was achieved the patient was placed in the right lateral decubitus position. the left hip and lower back as well as the abdomen and right upper extremity were prepped and drapped with betadine. i addressed the hand first. 2nd degree blisters were completely debrided off of all fingers and the hand. the area was then sscrubbed thoroughtly with a scrub brush, tangentially to exacerbate bleeding. bleeding was controlled with saline epinephrine soaked lap sponges and the hand was thorought ly dried and the size large biobrane glove was stretched over the hand and held in place under stretch at the wrist with staples. .....the ellipsis were drawn around the skin transversely at both the lower back as well as the abdomen. these areas were then excised with a 10 blade. bovie cautery was used to carry these burns which were quite deep and into the fat down throught into the subcutaneous tissue and upon adequate excision over the burn. scarpa's was reapproximated using interrupted 3-0 vicryl sutures and both skin incisions were closed using vertical matress sutures of 4-0 ethilon.....

I am so confussed with the burn codes... 16020 - 16030.


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## johnmeyer (Nov 27, 2011)

*I hope this helps*

Don't forget the "Rule of Nines," which states that the adult body is broken down into segments represented by percentages. It's 1% for the groin, 9% for each arm (includes hands and fingers), 9% for the head, 18% for each leg (includes feet and toes), 18% for the anterior trunk, and 18% for the posterior trunk. It's different for infants and childern because of their disproportional bodies.

Here's a link for a graphical representation and a better break down of the rule....  http://www.emedicinehealth.com/burn_percentage_in_adults_rule_of_nines/article_em.htm

Codes 16020 - 16030 would be used for dressings and/or debridement of 2nd degree burns (partial thinkness burns). What's stinky about your procedure note is that your provider noted his/her work as cm2 and not percentages using the Rule of Nines. Since your procedure note states that the right hand and wrist were treated for 2nd degree burns, you could use 16020 because another rule under the Rule of Nines is that 1% equals about the same size as the patient's hand (not yours).


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