What is ICD-10 code T31.22?

T31.22 is the ICD-10-CM diagnosis code for Burns involving 20-29% of body surface with 20-29% third degree burns. A burn injury affecting 20-29% of the body surface area with 20-29% of the burn being deep (third degree). T31.22 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. T31.22 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. T31.22 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. T31.22 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does T31.22 map to under V28?

T31.22 maps to CMS-HCC V28 385 (Severe Skin Burn or Condition). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does T31.22 pay in RAF?

T31.22 carries a community, non-dual, aged (CNA) RAF weight of 1.291 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for T31.22?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For T31.22, V28 maps to Severe Skin Burn or Condition at RAF 1.291 while V24 mapped to Severe Skin Burn or Condition at RAF 0.224. Both models can still appear in legacy data and in payer-specific lookback periods.

What documentation supports T31.22?

The second digit (2) indicates 20-29% third degree burns; this is a severe burn requiring intensive care and likely transfer to a burn center Ensure documentation clearly distinguishes between total body surface area burned and the percentage of deep burns Because T31.22 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM T31.22: Burns involving 20-29%

T31.22 maps to CMS-HCC V28 385 (RAF 1.291). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC Buddy coding tools

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Code lookupT31.22Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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)

T31.22

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Burns involving 20-29% of body surface with 20-29% third degree burns

A burn injury affecting 20-29% of the body surface area with 20-29% of the burn being deep (third degree).

Buddy Insight

CMS-HCC V28

Mapped

HCC 385

Severe Skin Burn or Condition

RAF 1.291

CMS-HCC V24

Mapped

HCC 162

Severe Skin Burn or Condition

RAF 0.224

ACA/HHS

Mapped

HCC 218

HHS-HCC 218

Varies by metal level

ESRD/PACE

Mapped

HCC 162

Severe Skin Burn or Condition

RAF 0.155

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

T31Burns classified according to extent of body surface involved

T31.2Burns involving 20-29% of body surface

T31.22Burns involving 20-29% of body surface with 20-29% third degree burns

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for T31.22 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for T31.22 in this effective period.

Related Child Codes

Official

T31.20Burns involving 20-29% of body surface with 0% to 9% third degree burns

T31.21Burns involving 20-29% of body surface with 10-19% third degree burns

Includes

Official

ICD-10-CM does not list Includes notes for T31.22 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for T31.22 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for T31.22 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for T31.22 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for T31.22 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Clear documentation that 20-29% of total body surface area is burned

Specific documentation that 20-29% of body surface has third-degree burns

Evidence that all burned areas are full-thickness (third-degree)

Burn assessment using validated tools showing depth and extent

MEAT Support

HCC Buddy guidance

Clear documentation that 20-29% of total body surface area is burned

Specific documentation that 20-29% of body surface has third-degree burns

Evidence that all burned areas are full-thickness (third-degree)

Burn assessment using validated tools showing depth and extent

Audit Caution

HCC Buddy guidance

Misunderstanding that both percentages are the same (20-29%) in this code

Inadequate documentation of burn depth assessment by qualified provider

Confusing partial thickness burns with areas of third-degree involvement

Failing to distinguish between thermal burns and chemical corrosions

Common Mistakes

HCC Buddy guidance

T31.21 — Burns 20-29% TBSA with 10-19% third degree (less third-degree involvement)

T31.32 — Burns 30-39% TBSA with 20-29% third degree (larger total area)

T31.20 — Burns 20-29% TBSA with no third degree involvement

T32.22 — Corrosions 20-29% TBSA with 20-29% third degree (chemical cause)

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 T31.22 an HCC code?

Yes. T31.22 (Burns involving 20-29% of body surface with 20-29% third degree burns) maps to Severe Skin Burn or Condition under the CMS-HCC V28 risk adjustment model (and Severe Skin Burn or Condition under V24), with a community non-dual aged RAF of 1.291. It is billable for payment year 2026.

Coder answer: T31.22 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: T31.22
Description: Burns involving 20-29% of body surface with 20-29% third degree burns
HCC (V28): HCC 385 — Severe Skin Burn or Condition
RAF: 1.291
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 385, Severe Skin Burn or Condition

1.291

V24HCC 162, Severe Skin Burn or Condition

0.224

ESRDHCC 162, Severe Skin Burn or Condition

0.155

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work T31.22 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for T31.22

For T31.22 to 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 T31.22 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

T31.22 is the ICD-10-CM diagnosis code for burns involving 20-29% of body surface with 20-29% third degree burns. A burn injury affecting 20-29% of the body surface area with 20-29% of the burn being deep (third degree). T31.22 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, T31.22 maps to Severe Skin Burn or Condition (HCC 385) with a community, non-dual, aged base RAF weight of 1.291. Under the older V24 model, T31.22 mapped to the same category but with a base RAF weight of 0.224, 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 (2) indicates 20-29% third degree burns; this is a severe burn requiring intensive care and likely transfer to a burn center. Because T31.22 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 T31.22 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•The second digit (2) indicates 20-29% third degree burns; this is a severe burn requiring intensive care and likely transfer to a burn center
•Ensure documentation clearly distinguishes between total body surface area burned and the percentage of deep burns

Clinical Significance

Burns involving 20-29% of body surface area where the entire burned area (20-29%) is third-degree represents severe burn injury with complete skin destruction requiring immediate specialized burn center management. This injury pattern has high morbidity and mortality risk, requiring extensive surgical intervention including escharotomy, debridement, and multiple skin grafting procedures.

Documentation Requirements

✓Clear documentation that 20-29% of total body surface area is burned
✓Specific documentation that 20-29% of body surface has third-degree burns
✓Evidence that all burned areas are full-thickness (third-degree)
✓Burn assessment using validated tools showing depth and extent
✓Documentation of eschar formation or other third-degree characteristics
✓Assessment by burn specialist or qualified provider
✓Evidence of need for surgical intervention
✓Documentation of systemic complications or risk factors

Commonly Confused Codes

•T31.21: Burns 20-29% TBSA with 10-19% third degree (less third-degree involvement)
•T31.32: Burns 30-39% TBSA with 20-29% third degree (larger total area)
•T31.20: Burns 20-29% TBSA with no third degree involvement
•T32.22: Corrosions 20-29% TBSA with 20-29% third degree (chemical cause)
•T31.33: Burns 30-39% TBSA with 30-39% third degree (larger area)