Injury Severity

🤔 Question: If a patient loses a limb in the process would that affect the TBSA at discharge since now he/ she has a body part that is missing? For example, if the patient comes with a 2.5% burn on the right hand and that hand gets amputated, at discharge that hand would be missing, therefore that burn area is not present anymore. Would the L&B still reflect that initial 2.5% TBSA?

🌱 Answer: Yes, in the case of a lost limb, the Lund & Browder would still be 2.5% 3rd degree to the Right hand. That area was burned and should be included even if amputated. 

Total Burn Size 2nd Degree

🤔 Question: It was noted that Xenograft could not be categorized as partial or full thickness and then it is never the final graft, that it's used as a temporary graft. Is this how xenograft is defined? How should this be correctly entered when coding as a procedure.

🌱 Answer: Determination of a partial thickness (2nd degree) or full thickness (3rd degree) can be made by whether the: 1) the wound heals on its own or 2) requires a permanent wound cover like a split or full thickness skin graft or cultured epithelial autograft (CEA). Xenograft generally comes from pigskin and provides temporary coverage of a wound. The use of xenograft cannot determine what the depth of the wound is, as it can be used on both partial and full thickness injuries.

🤔 Question: If the only procedure done on a burn is with RECELL, is that burn considered 3rd degree?

🌱 Answer: You can use a treatment option to determine which areas are second and third degree, but you must know what the use is for the treatment. For example, any area covered using an autograft (either a spilt or full-thickness autograft) is used to provide permanent coverage for a third-degree wound (full or deep partial thickness). Likewise, any area covered by cultured epidermal autograft (CEA) is also used to provide permanent coverage of a third-degree wound.
RECELL is a spray-on preparation of autologous cells intended for use in coverage of full and deep partial-thickness wounds, used alone or with widely meshed autologous skin grafts. It can provide permanent coverage of the wound. It can potentially also be used as a temporary coverage over wounds that are second-degree. It would be best to ask the surgeon what the depth of the wound is in cases where RECELL is being used without any other type of autograft.
There are several other wound coverage agents, and some are for temporary coverage of second-degree wounds. If you are not familiar with the various treatments being used, you should consult your burn surgeon to determine if the wound is second or third-degree. In general, all third-degree areas require permanent coverage material like an autograft. The difficulty for some patients is if they die before the wounds declare themselves and are covered, in which case you should rely on the surgeon to determine which wounds are second-degree and which are third-degree.

🤔 Question: If a patient is admitted after being seen in clinic multiple times and has only one burn diagram from a clinic visit, can that burn diagram be used as the initial TBSA even though it was completed weeks prior to admission?

🌱 Answer: If this burn diagram represents accurately the initial TBSA, then yes it can be used. A final (ultimate) burn diagram, with the accurate total TBSA of what was second and what was third degree should also be completed.

Carboxyhemoglobin Level

🤔 Question: Should a carboxyhemoglobin level be drawn if there is not an inhalation injury?  Is there a time frame that a carboxyhemoglobin level should be taken? 

🌱 Answer: If a carboxyhemoglobin level was taken, you should document it. Many times, they may draw one to rule out that there was or was not an inhalation injury. Carboxyhemoglobin levels should be taken as soon as possible to guide care, especially if concerned with inhalation injury. Related to the Registry documentation, you should enter the first level taken.