Pediatric Coding Alert

You Be the Coder:

Understand Lund-Browder Method to Code This Burn Case

Published on Mon Jul 08, 2024

Question: A 15-year-old boy saw our pediatrician with second-degree burns to his upper back, and entire right arm after falling into a campfire. The pediatrician debrided the burn and dresses it. Which code should I report?

Virginia Subscriber

Answer: In this example, you’ll want to use the Lund-Browder classification method. 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:

Identify the patient’s age category and select the appropriate chart.
Determine the extent of burn in each body section using the percentage values provided in the chart.
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.

Using this information, you can tell 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 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 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.