ICD-10 Spotlight: Know the codes (ICD-10 distinction between burns and corrosions)

September 28, 2012

Each month, IBC will feature an example of how ICD-9 codes will translate to ICD-10 codes. We will present coding examples from different specialties and popular disease categories to demonstrate the granularity that the new ICD-10 code set will provide.

CODING CONVENTION: ICD-10 coding burns and corrosions (continued from last month)

This article will convey the coding conventions used in assigning the appropriate codes for burns and corrosions. ICD-10 makes a distinction between burns and corrosions. In addition to the distinction, there are coding conventions that are essential in attaining the correct code assignment. These conventions include:

Sequencing

When more than one burn/corrosion is present, sequence the code that reflects the highest degree first. When the reason for the admission or encounter is for treatment of external burns/corrosions, sequence the code that reflects the highest degree first. When a patient has both internal and external burns/corrosions, the circumstances of admission govern the selection of the principal diagnosis (i.e., 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 diagnosis.

Burns/corrosions of the same local site

Classify burns of the same local site, but of different degrees, to the subcategory identifying the highest degree recorded in the diagnosis.

Non-healing and infected burns/corrosions

Non-healing and necrosis (death) of burned skin should be coded as acute burns. For any infected burn site, use an additional code for the infection.

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.

Extent of body surface involved (categories T31, T32)

Burns and corrosions classified according to extent of body surface involved should be assigned when the site of the burn is not specified or when there is a need for additional data such as evaluating burn mortality (usually needed by burn units), and 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? in estimating body surface area that has been burned. The Rule of Nines is a system that is based on the rough approximation that each arm has 9 percent of the body?s total skin, the head and neck have 9 percent, each leg 18 percent (two 9s), the front of the torso 18 percent, the back of the torso 18 percent, and the genitalia 1 percent.* *Providers may change these percentage assignments where necessary to accommodate infants and children who have proportionately larger heads than adults, and patients who have large buttocks, thighs, or abdomen that involve burns.

Encounter for treatment of sequela of burns/corrosions

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

Sequela and current burn

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

Use of 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.

Example: Burns of the same local site

Same local site Trunk Degree Sequencing Subcategory Chest Wall 1st degree Secondary diagnosis code Subcategory Abdominal Wall 2nd degree Principal diagnosis code For additional information related to the IBC transition to ICD-10, please visit the ICD-10 section of our website. On this site you will also find other examples of how ICD-9 codes will translate to ICD-10 codes in the ICD-10 Spotlight: Know the codes booklet.