Pediatric Coding Alert

Remember to review the ICD-10-CM guideline that clarifies sequencing rules.

When it comes to coding injuries such as burns, quickly finding the correct codes and properly sequencing them can be a challenge. The appropriate CPT^® code for the encounter can also be difficult to decipher, as the best choice might not even be a burn code.

Brush up on your burn coding and follow these four tips that will lead you to the right codes every time.

Tip 1: See the Acronym for Correct ICD-10 Coding

To correctly report burn diagnoses, remember the acronym S/S.E.E., says Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting, Inc. in Lansdale, PA. This will help you recall that you’ll need to report at least three ICD-10-CM codes.

“You’ll choose the first listed code from categories T20-T25 (Burns and corrosions of external body surface, specified by site) based on the Severity/Site of the burn(s). The next listed code, from code category T31 (Burns classified according to extent of body surface involved), will describe the condition’s Extent. And the final code will be from Chapter 20 (External causes of morbidity) and will describe the condition’s External cause,” says Falbo.

Example: A 7-year-old patient reports to your provider with a first-degree burn after spilling hot chocolate on her left thigh while riding in the car. Your provider examines the patient and tells her parent to apply petroleum jelly to the burn and to keep the area covered if blisters form. How would you code this encounter?

Using this acronym for this scenario, your coding should look something like this:

• T24.112A (Burn of first degree of left thigh, initial encounter)
• T31.0 (Burns involving less than 10% of body surface)
• X10.0XXA (Contact with hot drinks, initial encounter)

Why T31.0? The hardest part of burn coding involves calculating the amount of body surface area that has been burnt. One of the most detailed, and age-specific, ways to do this is the Lund-Browder classification method.

Tip 2: Understand the Lund-Browder Classification Method

The Lund-Browder Classification Method is a widely used system for estimating the percentage of total body surface area (TBSA) affected by burns in both children and adults. It’s particularly useful because it takes into consideration the variations in body proportions at different ages.

The method is based on two charts: one for children and one for adults. The charts divide the body into sections and assign percentage values to each section. These values depend on the patient’s age, as the distribution of body surface area changes with growth.

To use the Lund-Browder method:

1. Identify the patient’s age category and select the appropriate chart.

2. Determine the extent of burn in each body section using the percentage values provided in the chart.

3. Add up the percentages of all affected body sections to calculate the total body surface area affected by burns. This method provides a more accurate estimation of TBSA affected by burns, which helps guide treatment decisions and assess the severity of burn injuries.

This has the added advantage of being the system referenced by CPT^®. Using this method, a burn on a 17-year-old’s entire left thigh is classified as approximately 6.5 per cent of the total body area. This is less than 10 per cent, so T31.0 is the correct ICD-10-CM code to use to report the extent of the patient’s body surface affected by the burn in the scenario mentioned above.

Tip 3: Pick Multiple ICD-10-CM Codes for Larger Burns

When the burn is large enough to cover more than one anatomical site, you’ll need to report more than one code in many cases.

Example: A 15-year-old boy sees your provider with second-degree burns to his upper back, and entire right arm after falling into a campfire. The physician debrides the burn and dresses it.

In this example, the Lund-Browder classification tells you that the burn to the 15-year-old’s upper back and right arm represents approximately 18.5 per cent of the child’s body, or greater than 10 per cent of his total body area.

The burn occurs over part of the back and the whole arm, so therefore you will need four codes to document the injury site, which makes six total ICD-10-CM codes for this encounter:

• T21.23XA (Burn of second degree of upper back, initial encounter)
• T22.231A (Burn of second degree of right upper arm, initial encounter)
• T22.221A (Burn of second degree of right elbow, initial encounter)
• T22.211A (Burn of second degree of right forearm, initial encounter)
• T31.10 (Burns involving 10-19% of body surface with 0% to 9% third degree burns)
• X03.0XXA (Exposure to flames in controlled fire, not in building or structure, initial encounter)

Coding alert: Pay attention to varying degrees of severity when there are multiple burn sites. ICD-10-CM Guideline I.C.19.d.1 says to “Sequence first the code that reflects the highest degree of burn when more than one burn is present.” Guideline I.C.19.d.2 instructs you to assign to the highest degree in instances when different degrees of burn occur on the same anatomical site.

Tip 4: Identify When to Report E/M Only or Treatment Code

Minor burns don’t usually require much of the pediatrician’s time or attention, so “many providers might decide to only bill an evaluation and management (E/M) code as there is little actual treatment provided for a first-degree burn,” says Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington.

In the example above where the patient spilled hot chocolate on her thigh, that would probably just warrant coding 99202/99212 (Office or other outpatient visit for the evaluation and management of a new/established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making …) based on a single, self-limited, or minor problem and a minimal risk of complications from treatment.

However, that’s not a universal rule for all first-degree burns.