Escharotomy
1603516036wRVU: 1.46 — Each additional escharotomy incision27600wRVU: 5.88 — Fasciotomy, leg (if fasciotomy required in addition)25020wRVU: 5.91 — Fasciotomy, forearm (if forearm compartment syndrome)
Circumferential [full-thickness / deep partial-thickness] burns, [right / left / bilateral] [upper extremity / lower extremity / chest / hand] with [vascular compromise / compartment syndrome / respiratory restriction]
Same
Escharotomy, [right / left / bilateral] [upper extremity / lower extremity / chest], [X] incisions
[Attending name], MD
[Resident / Nurse name]
[None (unresponsive patient) / IV sedation and analgesia / General]
Patient presents with [X]% TBSA [full-thickness / deep partial-thickness] burns involving [circumferential extremity / circumferential chest]. [Distal pulses diminished / absent / loss of Doppler signal / compartment pressures [X] mmHg / progressive inability to ventilate with peak airway pressures [X] cmH2O.] Escharotomy required to restore perfusion / ventilation. Risks including bleeding and wound conversion to full-thickness discussed. Consent [obtained from patient / obtained from family / waived in emergency].
Inelastic, circumferential eschar [right / left upper extremity / bilateral lower extremities / chest]. [Distal hand / foot] capillary refill [absent / delayed >3 seconds]. Doppler signal [absent / present after escharotomy]. [Peak airway pressure improved from [X] to [X] cmH2O after chest escharotomy.]
[EXTREMITY:] The affected extremity was prepped with [betadine / chlorhexidine]. Longitudinal escharotomy incisions were made with [electrocautery / scalpel] along the [medial / lateral / bilateral medial and lateral] aspects of the [arm / forearm / thigh / leg], extending from [proximal to distal burn margin] through the full depth of the eschar to viable subcutaneous tissue. [Hand escharotomy: dorsal longitudinal incisions along the midaxial lines over the 2nd and 4th metacarpals (not over webspaces). Digital incisions placed on the radial side of the index and middle fingers, and ulnar side of the ring and small fingers. Thenar and hypothenar eminence incisions for compartment release if involved.]
[CHEST:] Bilateral anterior axillary line incisions were made from the clavicle to the costal margin. A transverse subcostal connecting incision was made. Chest excursion immediately improved. Peak airway pressure decreased from [X] to [X] cmH2O.
All incisions were assessed for bleeding. Hemostasis was achieved with electrocautery. [Distal Doppler signals confirmed after release.] Incisions covered with [Mepitel / Xeroform / silver-impregnated foam dressing (Mepilex Ag, Aquacel Ag)]. Silver sulfadiazine is avoided for superficial partial-thickness burns and donor sites (impairs re-epithelialization, forms pseudo-eschar that obscures wound assessment, associated with neutropenia). However, SSD remains in use at many ABA-verified burn centers for deep partial- and full-thickness wounds where re-epithelialization is not the primary concern. Modern silver-impregnated non-adherent dressings (Mepitel Ag, Aquacel Ag) are preferred where wound healing assessment and re-epithelialization are priorities.
Patient tolerated the procedure well.
None
None
[X] mL
None
Patient returned to burn ICU. Dressings in place. Hourly clinical reassessment of distal perfusion (Doppler, capillary refill) for the first 4-6 hours. Formal reassessment with wound inspection at 4-6 hours. Earlier reassessment if clinical deterioration.
Epic SmartPhrase Version
PREOPERATIVE DIAGNOSIS: Circumferential [full-thickness / deep partial-thickness] burns, [right / left / bilateral] [extremity / chest] with [vascular compromise / respiratory restriction]
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Escharotomy, [right / left / bilateral] [upper extremity / lower extremity / chest], *** incisions
ATTENDING SURGEON: ***, MD/DO
FIRST ASSISTANT: ***
ANESTHESIA: [None / IV sedation / General]
INDICATIONS: The patient is a .PTAGE-year-old .PTSEX with ***% TBSA circumferential [full-thickness / deep partial-thickness] burns. [Distal Doppler absent / compartment pressures *** mmHg / peak airway pressures *** cmH2O.] Escharotomy required. Consent [obtained / waived in emergency].
FINDINGS: Inelastic circumferential eschar. Distal perfusion [absent / compromised] preoperatively. [Doppler signal restored after escharotomy.] [Peak airway pressure improved from *** to *** cmH2O.]
DESCRIPTION OF PROCEDURE:
[EXTREMITY:] Extremity prepped. Longitudinal escharotomy incisions made with electrocautery along [medial / lateral / bilateral medial and lateral] aspects of [arm / forearm / thigh / leg] from proximal to distal burn margin through full eschar depth to viable subcutaneous tissue. [Hand escharotomy performed over dorsal webspaces and thenar/hypothenar eminences.] [CHEST:] Bilateral anterior axillary line incisions from clavicle to costal margin; transverse subcostal connecting incision; chest excursion immediately improved. Hemostasis with electrocautery. Distal Doppler confirmed after release. Incisions dressed with [Mepitel / Xeroform / silver-impregnated dressing]. Patient tolerated procedure well.
ESTIMATED BLOOD LOSS: *** mL
SPECIMENS: None
COMPLICATIONS: None
DRAINS: None
DISPOSITION: Patient to burn ICU. Reassessment at 4-6 hours.
Signed: .ME, .MYDEGREE
.TODAYVariants
Hand escharotomy
Dorsal longitudinal incisions along the midaxial lines over the 2nd and 4th metacarpals (not over webspaces). Digital releases placed on the radial side of index and middle fingers, and ulnar side of ring and small fingers. Thenar and hypothenar eminence incisions if those compartments involved. Intrinsic minus posture (clawing) is a sign of intrinsic compartment syndrome requiring this approach.
Concurrent fasciotomy
When underlying muscle compartment syndrome is suspected (crush + burns, high-voltage electrical injury), fasciotomy is required in addition to escharotomy. Bill separately. Document compartment pressure measurements.
Charting Tips
- {'Document indication': 'absent Doppler, compartment pressures, or peak airway pressures'}
- State exact incision locations and length
- Note Doppler signal before and after for extremity escharotomy
- For chest escharotomy, document pre/post peak inspiratory pressures
- Record bleeding from incisions as a sign of viable tissue at incision depth
- {'Document hourly post-procedure Doppler/perfusion checks and formal reassessment at 4-6 hours. If Doppler does not return after escharotomy, consider concurrent fasciotomy (threshold': 'compartment pressure >30 mmHg or delta-P [diastolic BP minus compartment pressure] <30 mmHg).'}
Billing Tips
- Bill 16035 for escharotomy, initial incision (3.65 wRVU, 0-day global). Bill 16036 for each additional incision (+1.46 wRVU per incision, add-on code, no modifier -51). Document the number and location of each escharotomy incision, as each incision is separately counted.
- Chest escharotomy (for respiratory compromise from circumferential trunk burns) uses the same codes as extremity escharotomy. Document the indication (elevated peak airway pressures, inability to ventilate) and incision lines (anterior axillary lines + subcostal transverse connecting incision).
- Escharotomy is distinct from fasciotomy (which releases the fascia deep to the burn). If fasciotomy is required concurrently for compartment syndrome (underlying crush injury or combined mechanism), bill fasciotomy codes (27600-27602 for leg, 25020 for forearm) separately. Document clearly which procedure was performed.
- 0-day global period: no postoperative bundling. Dressing changes, wound care, and reassessment are separately billable. Escharotomy incisions are often converted to skin graft wounds in subsequent procedures.
- Escharotomy performed at the bedside vs. in the OR does not change the CPT. Document the setting, indication, and that the procedure was performed by a physician. Escharotomy indication is based on circumferential full-thickness burn causing vascular or ventilatory compromise, not total TBSA. A small circumferential arm burn can require escharotomy regardless of total body surface area. Burns >20% TBSA with circumferential components commonly require escharotomy, but the threshold is clinical (absent Doppler, elevated compartment pressures, or elevated peak airway pressures), not a TBSA cutoff.
General coding reference. Verify with your institution’s billing department before submitting claims.