Anesthesia Coding Alert

ICD-10 will keep additional TBSA code.

Coding burns based on body site and "degree" plus an additional code for total body surface area (TBSA) won't change when you start using ICD-10 in Oct. 2013. The new detail you'll include will be reporting the cause of the burn.

ICD-10 Distinguishes Burn Source

Under ICD-9, a burn is a burn. ICD-10 offers another option by giving you the choice of "corrosion," or chemical burn.

Example: Let's say a patient has a second degree burn of the right thigh from accidentally spilling boiling water. Under ICD-9, you'd report the condition as 945.26 (Blisters with epidermal loss due to burn [second degree] of thigh [any part]). For ICD-10, you should list T24.211- (Burn of second degree of right thigh...). Notice that the ICD-10 descriptor includes "right" -- meaning that you'll want to remind providers that every detail counts when you're selecting the best diagnosis.

Now let's say you have the exact scenario, except the burn is from an accidental spill of a strong acid. With ICD-9 you would still use 945.26. But for ICD-10, you'll use a different code -- T24.611- (Corrosion of second degree of right thigh...).

Like ICD-9, you'll also need to list a distinct ICD-10 code indicating the extent of burns (or corrosions) using a unique TBSA (total body surface area) code.

For instance: Assume the prior two examples involved 11 percent of the patient's total body surface area with no third degree burns. In ICD-9, you'd report 948.10 (Burn [any degree] involving 10-19 percent of body surface with third degree burn of less than 10 percent or unspecified amount).

But for ICD-10, you'll have two TBSA choices based on the burn/corrosion distinction:

• T31.10 -- Burns involving 10-19% of body surface with 0% to 9% third degree burns
• T32.10 -- Corrosions involving 10-19% of body surface with 0% to 9% third degree corrosion.

Corrosions take more: Not only do you have distinct "corrosion" codes in ICD-10, you also need to report a unique code to identify the cause of the chemical burn. Preceding the corrosion codes, ICD-10 provides this instruction: Code first: (T51-T65) to identify chemical and intent.

In our prior example, you would report the acid burn to the thigh by reporting first T54.2x1- (Toxic effect of corrosive acids and acid-like substances, accidental [unintentional]).