T31.43: Burns involving 40-49% of body surface with 30-39% third degree burns

Risk adjustment

T31.43 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 385 Severe Skin Burn or Condition1.291 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

T31.43 is named in 9 Medicare coverage policies: 7 listing it as supporting medical necessity, and 2 listing it as NOT covered. Which one applies depends on your Medicare contractor.

• A56566Billing and Coding: Outpatient Physical and Occupational Therapy Servicesnot covered
• A57067Billing and Coding: Outpatient Physical and Occupational Therapy Servicesnot covered
• A52438Billing and Coding: Tetanus Immunization
• A53065Billing and Coding: Outpatient Physical Therapy