T31.97
BillableBurns involving 90% or more of body surface with 70-79% third degree burns
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is T31.97 an HCC code?
Yes. T31.97 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 T31.97
For T31.97to 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 T31.97 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
T31.97 is the ICD-10-CM diagnosis code for burns involving 90% or more of body surface with 70-79% third degree burns. Severe burns covering 90% or more of the body with 70-79% being third-degree burns affecting the majority of the burned surface. T31.97 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, T31.97 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, T31.97 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.
These catastrophic injuries require comprehensive documentation of all body regions affected. Because T31.97 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 T31.97 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •These catastrophic injuries require comprehensive documentation of all body regions affected
- •Include codes for life support, mechanical ventilation, or other critical interventions
Clinical Significance
Burns involving 90% or more of body surface area with 70-79% third-degree burns represent the most catastrophic thermal injury with survival rates approaching zero without immediate, aggressive intervention. This injury pattern is incompatible with life without extensive life support, massive transfusion protocols, and extraordinary surgical intervention, typically requiring palliative care considerations alongside aggressive treatment.
Documentation Requirements
- ✓Documentation of 90% or greater total body surface area involvement
- ✓Clear documentation that 70-79% of body surface has third-degree burns
- ✓Burn specialist assessment confirming the catastrophic nature of injury
- ✓Evidence of immediate life support interventions and resuscitation efforts
- ✓Documentation of burn center admission with highest level of care capability
- ✓Assessment of viability and treatment goals including palliative considerations
- ✓Documentation of family discussions regarding prognosis and goals of care
- ✓Comprehensive documentation of all supportive measures and interventions
Commonly Confused Codes
- •T31.96 — Burns 90%+ TBSA with 60-69% third degree (less third-degree involvement)
- •T31.98 — Burns 90%+ TBSA with 80-89% third degree (more third-degree involvement)
- •T31.87 — Burns 80-89% TBSA with 70-79% third degree (smaller total area)
- •T32.97 — Corrosions 90%+ TBSA with 70-79% third degree (chemical cause)
- •T31.99 — Burns 90%+ TBSA with 90%+ third degree (maximum severity)