T31.11
BillableBurns involving 10-19% of body surface with 10-19% third degree burns
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is T31.11 an HCC code?
Yes. T31.11 maps to Severe Skin Burn or Condition under the CMS-HCC V28 risk adjustment model (and Severe Skin Burn or Condition under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for T31.11
For T31.11to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- 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
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed T31.11 during that encounter — not just copy-forwarded from a problem list.
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 community, non-dual, aged base RAF weight of 0.350. Under the older V24 model, T31.11 mapped to the same category but with a base RAF weight of 0.517 — V28 recalibrated weights across the entire model. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
The second digit (1) indicates 10-19% third degree burns; this represents a more serious burn than T31.10. Because T31.11 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, 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)