T31.11 ICD-10-CM Code: Burns involving 10-19% of body surface with 10-19% third degree burns
T31.11 maps to CMS-HCC V28 385. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Injury, poisoning and certain other consequences of external causes (S00-T88) / Burns and corrosions of multiple and unspecified body regions (T30-T32)
T31.11
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceBurns involving 10-19% of body surface with 10-19% third degree burns
A burn injury affecting 10-19% of the body surface area with 10-19% of the burn being deep (third degree).
Buddy Insight
Burns involving 10-19% of body surface area with equivalent third-degree involvement represent moderate but significant thermal injury requiring specialized burn care.
CMS-HCC V28
MappedHCC 385
Coefficient HCC 385: 1.291 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 218
Code-level coefficient reference
ESRD/PACE
MappedHCC 162
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for T31.11. Check the code and parent instructions in the Code Book.
Excludes 2
Official- birth trauma (P10-P15)Inherited from S00-T88
- obstetric trauma (O70-O71)Inherited from S00-T88
Related Codes
Includes
OfficialNo Includes notes are included in this display for T31.11. Check the code and parent instructions in the Code Book.
Excludes 1
OfficialNo Excludes 1 notes are included in this display for T31.11. Check the code and parent instructions in the Code Book.
Code First
OfficialNo Code First sequencing instructions are included in this display for T31.11. Check the code and parent instructions in the Code Book.
Use Additional
Official- code to identify any retained foreign body, if applicable (Z18.-)Inherited from S00-T88
Code Also
OfficialNo Code Also instructions are included in this display for T31.11. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is T31.11 an HCC code?
Yes. T31.11 (Burns involving 10-19% of body surface with 10-19% third degree burns) maps to HCC 385, Severe Skin Burn or Condition under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 1.291. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: T31.11 is billable and maps to V28 HCC 385, Severe Skin Burn or Condition. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- T31.11
- Description
- Burns involving 10-19% of body surface with 10-19% third degree burns
- HCC (V28)
- HCC 385 — Severe Skin Burn or Condition
- RAF reference coefficient
- 1.291
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work T31.11 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for T31.11
For T31.11, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Coder workflow notes
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What This Code Means
T31.11 is the ICD-10-CM diagnosis code for burns involving 10-19% of body surface with 10-19% third degree burns. A burn injury affecting 10-19% of the body surface area with 10-19% of the burn being deep (third degree). T31.11 sits in the ICD-10-CM chapter for injury, poisoning and certain other consequences of external causes (s00-t88), within the section covering burns and corrosions of multiple and unspecified body regions (t30-t32).
Under the CMS-HCC V28 risk adjustment model, T31.11 maps to Severe Skin Burn or Condition (HCC 385) with a source-labeled community, non-dual, aged reference coefficient of 1.291. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
The second digit (1) indicates 10-19% third degree burns; this represents a more serious burn than T31.10. For T31.11, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for T31.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •The second digit (1) indicates 10-19% third degree burns; this represents a more serious burn than T31.10
- •Verify documentation clearly specifies both the total body surface area percentage and the percentage of third degree involvement
Clinical Significance
Burns involving 10-19% of body surface area with equivalent third-degree involvement represent moderate but significant thermal injury requiring specialized burn care. This level of burn injury typically requires hospitalization, fluid resuscitation, and may need surgical intervention including debridement and skin grafting.
Documentation Requirements
- ✓Calculation and documentation of total body surface area (TBSA) burned using Rule of Nines or Lund-Browder chart
- ✓Specific documentation that 10-19% of body surface is involved
- ✓Clear documentation that 10-19% of the burned area is third-degree (full thickness)
- ✓Description of burn depth extending through all skin layers
- ✓Documentation of anatomical locations affected
- ✓Cause of burn injury (thermal, electrical, chemical, radiation)
- ✓Assessment by qualified healthcare provider trained in burn evaluation
- ✓Treatment plan including fluid resuscitation calculations if applicable
Commonly Confused Codes
- •T31.10: Burns 10-19% TBSA with 0% third degree (no full thickness involvement)
- •T31.21: Burns 20-29% TBSA with 10-19% third degree (larger total burn area)
- •T20-T25 codes: Specific anatomical burn sites (used in addition to, not instead of T31)
- •T32.11: Corrosions 10-19% TBSA (chemical burns, not thermal)
- •T31.01: Burns <10% TBSA with <10% third degree (smaller burn area)