Burn of second degree of left shoulder, sequela

This code signifies a second-degree burn affecting the left shoulder, indicating damage to the epidermis and dermis, characterized by blistering, pain, and redness. The "S" seventh character denotes that this encounter is for the sequelae (late effects) of the burn, meaning the acute injury has healed, but residual complications or conditions persist.

Use this code when documenting follow-up care for long-term complications arising from a healed second-degree burn to the left shoulder. This includes scenarios such as scar contractures, chronic pain, keloids, or other persistent issues directly attributable to the original burn injury. It should not be used for the initial treatment of the acute burn.

• Always ensure the "S" seventh character is appended for sequela encounters, indicating late effects.
• Code any specific sequela (e.g., scar, contracture) first, then use this code as a secondary diagnosis to identify the original cause.
• Verify laterality (left shoulder) and burn depth (second degree) are accurately documented in the patient's medical record.