Definition and degree of Burn

Burn is an injury caused by exposure to heat or flame. Burn are classified into different degree to code the most specific ICD 10 code. Tissue injury or death caused by heat, flame, chemical, electricity, or radiation; the depth of a burn is measured by degree.

To know more specific about degree of burns, let us check them in more detail.

First Degree

Damage from first-degree burns is limited to the outer layer of the epidermis, with erythema and increased tenderness. First-degree burns have good capillary refill and do not represent significant injury in terms of fluid replacement needs.

Second Degree

Second-degree burns represent a partial-thickness injury to the dermis, which may be either superficial or deep. Deep second-degree burns heal much more slowly than first-degree burns and are prone to developing infection. The end result of second-degree burns may be hypertrophic scarring.

Third Degree

In third-degree burns, the dermal barrier is lost, and the presence of necrotic tissue creates fluid volume loss with systemic effects on capillaries well away from the burn site. In addition, the burn site establishes an ideal culture medium for infection, which may be life threatening. The critical factor in healing of third-degree burns is blood supply. Areas rich in blood supply, such as hair follicles and sweat glands, have a better chance for reepithelialization.

Deep third-degree burns are characterized by an underlying necrosis with thrombosed vessels. Codes for burns of this depth are assigned only on the basis of a specific diagnosis made by the physician.

ICD 10 Coding guidelines for burn

1) Sequencing of burn and related condition codes

Sequence first the code that reflects the highest degree of burn when more than one burn is present.

When the reason for the admission or encounter is for treatment of external multiple burns, sequence first the code that reflects the burn of the highest degree.
When a patient has both internal and external burns, the circumstances of admission govern the selection of the principal diagnosis or first-listed diagnosis.
When a patient is admitted for burn injuries and other related conditions such as smoke inhalation and/or respiratory failure, the circumstances of admission govern the selection of the principal or first-listed diagnosis.

2) Burns of the same local site

Classify burns of the same local site (three-character category level, T20-T28) but of different degrees to the subcategory identifying the highest degree recorded in the diagnosis.

3) Non-healing burns

Non-healing burns are coded as acute burns. Necrosis of burned skin should be coded as a non-healed burn.

4) Infected burn

For any documented infected burn site, use an additional code for the infection.

5) Assign separate codes for each burn site

When coding burns, assign separate codes for each burn site. Category T30, Burn and corrosion, body region unspecified is extremely vague and should rarely be used.

6) Burns and corrosions classified according to extent of body surface involved

Assign codes from category T31, Burns classified according to extent of body surface involved, or T32, Corrosions classified according to extent of body surface involved, when the site of the burn is not specified or when there is a need for additional data. It is advisable to use category T31 as additional coding when needed to provide data for evaluating burn mortality, such as that needed by burn units. It is also advisable to use category T31 as an additional code for reporting purposes when there is mention of a third-degree burn involving 20 percent or more of the body surface.

Categories T31 and T32 are based on the classic “rule of nines”.

The size of a burn is measured by the percentage of total body surface affected; the system for calculating the percentage is the “rule of nines:”

Each arm 9%
Each leg 18%
Anterior trunk 18%
Posterior trunk 18%
Head and neck 9%

Sum of the percentages 99% (The perineum accounts for the remaining 1%)

7) Encounters for treatment of sequela of burns

Encounters for the treatment of the late effects of burns or corrosions (i.e., scars or joint contractures) should be coded with a burn or corrosion code with the 7th character “S” for sequela.

8) Sequelae with a late effect code and current burn

When appropriate, both a code for a current burn or corrosion with 7th character “A” or “D” and a burn or corrosion code with 7th character “S” may be assigned on the same record (when both a current burn and sequelae of an old burn exist). Burns and corrosions do not heal at the same rate and a current healing wound may still exist with sequela of a healed burn or corrosion.

9) Use of an external cause code with burns and corrosions

An external cause code should be used with burns and corrosions to identify the source and intent of the burn, as well as the place where it occurred.

Sample Coded Scenarios for Burn

First-, second-, and third-degree burns of body; 10 percent first degree, 15 percent second degree, and 32 percent (over the trunk) third degree; patient is crew member of ferry boat steamship on which boiler exploded

T21.30xA

T31.53

V93.51xA

Y99.0

V93.09xA

First-degree burns of back of left hand due to hot tap water in home where patient was visiting

T23.162A

X11.8xxA

Y99.8

Y92.099

Acid burns to left cornea from nitric acid

T54.2x1A