Podiatry Coding & Billing Alert

Make sure to differentiate “burns” from “corrosion.”

Reporting the correct ICD-10 code for burns can be tricky because you must consider so many different pieces of information. For example, you must know the exact site of the burn, the severity, the type of encounter, and the external cause of the injury.

Read on to keep your burn claims out of hot water.

Determine Exact Burn Location and 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.

For burins and corrosions of the ankle and foot, you will look in category T25- (Burn and corrosion of ankle and foot). The podiatrist should always document the site of the burn as specifically as possible. For instance, the 5th character in the T25- family represents the following, more specific sites of the foot:

• 1- ankle. For example: T25.311A (Burn of third degree of right ankle, initial encounter)
• 2- foot. For example: T25.321A (Burn of third degree of right foot, initial encounter)
• 3- toes (nail). For example: T25.331A (Burn of third degree of right toes(s) (nail), initial encounter)

Distinguish ‘Burn’ from ‘Corrosion’

You must also carefully read your podiatrist’s documentation to see if the patient has a corrosion or burn because ICD-10 differentiates between burns and corrosions. So, you will report different codes for each condition.

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.

Coding example: A patient comes into the podiatrist’s office with a corrosion on the top of her right foot that she sustained from battery acid. This is an initial encounter, and the corrosion is first degree. You should report T25.521A (Corrosion of first degree of right foot, initial encounter) as the ICD-10 code on your claim.

Find Out Severity of Burn

When dealing with burns, you must also read the medical documentation to see the 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.

For example, for burns, take a look at your character choices:

• First degree- T25.1- (Burn of first degree of ankle and foot)
• Second degree- T25.2- (Burn or second degree of ankle and foot)
• Third degree- T25.3- (Burn of third degree of ankle and foot)

And, for corrosions, you will choose from these characters:

• T25.5- (Corrosion of first degree of ankle and foot)
• T25.6- (Corrosion of second degree of ankle and foot)
• T25.7- (Corrosion of third degree of ankle and foot)

Don’t Forget 7^th Character

When you report the burn codes, you will see that the codes have seven characters. That seventh character denotes the type of encounter. Take a look at the different characters you will see:

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

Coding solution: A patient comes into the podiatrist’s office after dropping scalding hot coffee on the top of his right foot. This is an initial encounter. The podiatrist examines the patient and concludes that he has a first degree burn on the top of his foot. You should report T25.121A (Burn of first degree of right foot, initial encounter) as the ICD-10 code on your claim.

Remember Additional External Causes or Chemicals