ICD 10 Coding Alert

Know how these categories — location, severity, and type — determine burn code choices.

Distinguishing between burn types is one key element of determining the appropriate diagnosis and choosing the correct diagnosis code.

See how this ICD-10-CM guidance for burns can bolster your coding.

Determine Location, Site

The surgeon will assess burn severity as first, second, or third degree. First-degree burns usually only redden the skin, while second-degree (partial thickness) burns affect both the outer and underlying skin layers, causing pain, redness, swelling, and extensive blistering. Third-degree (full thickness) burns extend into deeper tissues and cause white or blackened, charred skin that may be numb because the burn trauma has destroyed the nerve endings.

An anesthesiologist will be called in to assist during treatment for third-degree and possibly second-degree burns, says Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Florida.

ICD-10-CM describes specific external sites in several code families:

• T20 (Burn and corrosion of head, face, and neck)
• T21 (... trunk)
• T22 (... shoulder and upper limb, except wrist and hand)
• T23 (... wrist and hand)
• T24 (... lower limb, except ankle and foot)
• T25 (... of ankle and foot)

Top tip: These code families represent very broad site categories, but the physician should document the site more specifically. You’ll need that information as you zero in on the most specific burn code. For instance, the 5th character in the T21 family represents the following, more specific sites on the trunk:

• 0 - unspecified site
• 1 - chest wall
• 2 - abdominal wall
• 3 - upper back
• 4 - lower back
• 5 - buttock
• 6 - male genital region
• 7 - female genital region
• 9 - other site of trunk

Distinguish ‘Burn’ from ‘Corrosion’

Once you’ve settled on the correct code family in the range T20-T25 based on body site, you’ll notice that the third character indicates two pieces of information that you need to acquire from the surgeon’s note in order to select the proper code. The first piece is whether you’re dealing with a corrosion or burn.

ICD-10 differentiates between burns and corrosions. Remember this:

• Burn codes describe thermal burns caused by a heat source, such as a fire, and burns resulting from electricity or radiation.
• Corrosion codes describe burns caused by chemicals, such as battery acid.

The ICD-10-CM guidelines are the same for both burns and corrosions, says Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, chief executive officer with Edelberg + Associates in Baton Rouge, La.

Find Out Severity of Burn

The second piece of information indicated by the 4th character of codes T20-T25 is burn severity. Classify severity based on the depth of the burn: first degree is characterized by erythema, second degree by the presence of blistering, and third degree by full-thickness involvement (epidermis and dermis).

Combine this knowledge with whether you’re dealing with a burn or corrosion to select the correct fourth character.

Example 1: If you’re coding a chemical burn (corrosion) on the torso, you’ll select one of the following codes:

• T21.4--- (Corrosion of unspecified degree of trunk)
• T21.5--- (Corrosion of first degree of trunk)
• T21.6--- (Corrosion of second degree of trunk)
• T21.7--- (Corrosion of third degree of trunk)

For a thermal or electrical burn at the same site, you’ll select one of the following codes instead:

• T21.0--- (Burn of unspecified degree of trunk)
• T21.1--- (Burn of first degree of trunk)
• T21.2--- (Burn of second degree of trunk)
• T21.3--- (Burn of third degree of trunk)

Example 2: Put this “type” (burn or corrosion) and “severity” information together with the 5th-character body-site information discussed in Tip 1, and you’ll have a five-character code such as T21.15- (Burn of first degree of buttock).

Important: This code still isn’t complete, because you must always report a 7th character indicating the encounter, as follows:

• A — initial encounter
• D — subsequent encounter
• S — sequela

ICD-10 uses the X placeholder when a code that requires a 7th character is not six characters in length; in these cases, you must use X to fill in the empty characters. So, if you’re coding for the first encounter for a first-degree burn of the buttock, you should code T21.25XA (Burn of second degree of buttock, initial encounter) as the complete seven-character code.

Don’t Forget Additional External Causes or Chemicals

As you sift through your coding options, pay attention to ICD-10 notes that direct you to additional codes to report the external cause of the burn or corrosion and the chemical agent for corrosions.

For burns, you’re directed to use an additional external cause code to identify the source, place, and intent of the burn (X00-X19, X75-X77, X96-X98, Y92). For corrosions, you should choose first from diagnoses T51-T65 to identify the chemical and intent, followed by any additional external cause code to identify the place (Y92).