A burn is an acute wound, defined as an injury to the skin or other organic tissue primarily caused by thermal or other acute trauma.
Caused By –
- Hot liquids (scalds)
- Hot solids (contact burns)
- Flames (flame burns)
- Friction or contact with chemicals
Burn Depth and Classification
First Degree (Superficial or Epidermal) Burns These burns involve only the epidermis. They do not blister, but are red and quite painful. Over 2-3 days the erythema and the pain subside. By about day 4, the injured epithelium peels away from the newly healed epidermis underneath, a process which is commonly seen after sunburn.
Second Degree (Partial Thickness) Burns Partial-thickness burns involve the epidermis and portions of the dermis.
- Superficial partial-thickness
- Deep partial-thickness burns.
Superficial partial-thickness burns – Blisters between the epidermis and dermis.
Deep partial-thickness burns – Extend into the lower layers of the dermis.
Third Degree (Full-Thickness) Burns Full-thickness burns involve all layers of the dermis and often injure underlying subcutaneous adipose tissue as well. Burn eschar is structurally intact but dead and denatured dermis. Some fullthickness burns involve not only all layers of the skin, but also deeper structures such as muscle, tendon, ligament and bone, and are classified as deep full-thickness or fourth-degree. Grafting may use autologous skin grafts or biologic dressings and skin substitutes or both. Deep full-thickness burns may require amputation or closure with alternative techniques (such as adjacent tissue transfer or microvascular procedures).
Escharotomy —An escharotomy is defined as a surgical incision through burn eschar (necrotic skin). Technique—Escharotomy (incision through the eschar) releases the constricting tissue allowing the body tissues and organs to maintain their normal perfusion and function.
Debridement of Burn —Debridement is the removal of loose, devitalized, necrotic, and/or contaminated tissue, foreign bodies, and other debris on the wound using mechanical or sharp techniques (such as curetting, scraping, rongeuring, or cutting). The level of debridement is defined by the level of the tissue removed, not the level exposed by the debridement process. Debridement cleans the wound and allows it to heal more rapidly with reduced risk of infection. In general, debridement is performed on shallow burns that are expected to heal without the need for skin grafting.
Excision of Burn Wounds —Excision is a surgical procedure requiring incision through the deep dermis (including subcutaneous and deeper tissues) of open wounds, burn eschar, or burn scars. Excision is typically performed on deep burns that would not heal on their own. The goal is to remove all necrotic and non-viable tissue and to prepare the wound for immediate or delayed wound closure.
Burn debridement (cleaning) and excision (escharectomy) are routinely performed by experienced burn surgeons. Though the techniques and instruments used for debridement and excision are often similar, burn excision is significantly more difficult and requires greater time and physical effort to achieve meticulous burn wound preparation for subsequent grafting with synthetic or biological materials.
Tangential excision (which is usually performed on deep partial thickness burns) Tangential excision involves surgical removal of successive layers of the burn wound down to viable dermis
Full thickness excision —often using electrocautery—involves removal of the burn wound down to viable subcutaneous tissue or to fascia.
Skin Substitutes and Skin Replacements
Skin substitute : A biomaterial, engineered tissue or combination of materials and cells or tissues that can be substituted for skin autograft or allograft in a clinical procedure.
Skin replacement: A tissue or graft that permanently replaces lost skin with healthy skin.
The procedure codes (16020 – 16030) are used to report the local treatment of the burn wound itself. These codes do not include evaluation and management services. The usual pre- and post-procedural services (e.g., explaining procedures to the patient/family, supervising the positioning and prepping of patient; monitoring stability of the patient, as appropriate; and after care instruction) are included in the debridement/dressing CPT code and not reported separately.
Surgical preparation for Burn Surgery codes (15002 – 15005) Vs Burn Debridement/Dressing change codes (16020 – 16030)
There are several CPT codes related to burn coding that I want to share with you to enhance your coding and reimbursement. These codes refer to local treatment of burned surface area only.
Burn dressing and/or debridement codes (16020-16030) are divided based on whether the dressing or debridement is of a small, medium, or large area. Small is less than 5% of the total body surface area, medium is the whole face or whole extremity, or 5% to 10% of the total body surface area, and large is more than one extremity or greater than 10% of the total body area.
- 16000 – Initial treatment, first degree burn, when no more than local treatment is required
- 16020 – Dressings and/or debridement, initial or subsequent; without anesthesia, office or hospital, small
- 16025– Dressings and/or debridement, initial or subsequent; without anesthesia, medium eg, whole face or whole extremity)
- 16030– Dressings and/or debridement, initial or subsequent; without anesthesia, large eg, more than one extremity)
- 16035 – Escharotomy
- 16036 – Escharotomy, each additional incision List separately in addition to code for primary procedure
When using these burns codes, remember to document percentage of body surface involved and depth of burn. Remember your “Rule of Nines” in calculating Total Body Surface Area.
These codes can be used in addition to an office visit; however, the office visit must be medically necessary and a modifier -25 must be appended to the office visit. An example of a medically necessary office visit would be to prescribe medications (such as antibiotics and/or pain medication, for example).