ICD code T22.191S – First-degree burn of right shoulder and upper limb, multiple sites, sequela

Key takeaways

T22.191S is the billable ICD-10-CM code for the sequela of a first-degree burn at multiple sites of the right shoulder and upper limb. The left side (T22.192S) and unspecified side (T22.199S) have their own codes.

The 7th character S designates sequela. Use it only after the burn has healed, when the visit treats a late effect rather than the active burn.

Claims are usually denied for an S applied to an active wound, a missing causal link to the prior burn, or the wrong laterality.

Pabau, the practice management platform we build, lets billers submit T22.191S claims through the Claim.MD integration, with the original burn notes in the same record.

ICD-10 Code T22.191S: Definition and clinical description

In clinical terms, “first degree” means a superficial burn of the epidermis only, with erythema and pain but no blistering or dermal involvement. Once it heals, it can leave late effects such as itching or hyperpigmentation. T22.191S reports those late effects.

The 7th character S tells the payer that the visit treats a late effect of the healed burn, not the burn in its active phase. Which sites count as “multiple” is covered in the section on what “multiple sites” means below.

The code is valid in the FY 2027 code set, effective October 1, 2026, and you can bill it as written.

Code details at a glance

The reference table below captures the key attributes of T22.191S that coders verify before submitting a claim.

Understanding the 7th character “S” in burn sequela coding

The 7th character S designates sequela, a residual condition that persists after the original burn has healed. The ICD-10-CM Official Guidelines for Coding and Reporting require two codes for a sequela. The condition or nature of the sequela is sequenced first, and the injury code with S follows it. For burns, the guidelines name scars and joint contractures as typical late effects.

The three 7th characters used across burn codes serve distinct purposes. Applying the wrong character is a common cause of claim rejection on injury codes.

The medical record must establish that the burn has fully healed before sequela coding applies. If the wound remains open or treatment is ongoing, character A or D applies instead. Applying S while the injury is still active is an audit risk and a common payer denial trigger.

What “multiple sites” means

In category T22, “multiple sites” means the burn involved two or more sites of the shoulder and upper limb on the same side. The official guidelines limit these codes to records that do not specify the individual sites (Section I.C.19.d.5).

When the provider names each burned site, code each one separately with its own single-site code. On the right side, the first-degree sequela codes are:

• Forearm: T22.111S
• Elbow: T22.121S
• Upper arm: T22.131S
• Axilla: T22.141S
• Shoulder: T22.151S
• Scapular region: T22.161S

Two areas sit outside T22 entirely. The wrist and hand are coded under T23, and the interscapular region is coded under T21.

If the note only says “burns to the right arm,” query the treating provider before you assign T22.191S. The guidelines prefer single-site codes whenever the sites are documented, so one clarifying answer can change the code.

T22.191S in the T22 code hierarchy

T22.191S occupies a specific leaf node within the T22 category. Understanding its siblings clarifies when laterality or degree changes require a different code.

Note that T22.191 codes the right side. Coders sometimes assume “191” is a generic unspecified code because it precedes “192” for the left. The tabular list confirms: T22.191x = right, T22.192x = left, T22.199x = unspecified. Verify laterality in the clinical record before defaulting to T22.199S.

Codes commonly confused with T22.191S

Several codes sit adjacent to T22.191S in the tabular list and share part of its descriptor. Five checks against the original burn note decide between them, in the order shown below.

The table adds each sibling’s short descriptor and the documentation detail that separates it from T22.191S.

Burn vs corrosion: Why the distinction matters at T22

A corrosion is a burn caused by a chemical agent, not a thermal source. ICD-10-CM keeps the two apart: T22.1- covers first-degree burns at this site, while T22.5- covers first-degree corrosions at the same site. T22.6- is second-degree corrosion, so it does not apply to a first-degree injury. The mechanism matters because it affects treatment, prognosis, and sometimes payer medical necessity criteria.

The mechanism also sets the external cause code. A burn from contact with hot air or hot gases takes X14.1XXS on a sequela visit.

• Thermal burn (T22.191S): Caused by heat, flame, radiation, or hot surfaces
• Corrosion (T22.591S): Caused by a chemical agent such as acid, alkali, or solvent
• Documentation clue: If the record mentions a chemical or substance, use the first-degree corrosion subcategory T22.5-, not T22.1-

Sequela and scar: How T22.191S and L90.5 work together

T22.191S and L90.5 are partners, not alternatives. L90.5 names the scar, which is the residual condition, while T22.191S records that a healed first-degree burn caused it. Under the official sequela guideline, L90.5 is listed first and T22.191S second.

First-degree burns rarely leave a scar, so pigment change or itching is the more common late effect. A documented scar can lead a payer to question whether the original burn was first degree, so check the original note.

• L90.5 + T22.191S: The provider documents a scar at the burn sites and links it to the healed first-degree burn.
• Another residual code + T22.191S: The late effect is something else, such as pruritus or a contracture. That condition’s code goes first, followed by T22.191S.
• L90.5 alone: The scar is treated, but the record does not tie it to the prior burn. Query the provider before you leave out the sequela code.

Documentation requirements for T22.191S claims

Medical record documentation must support the elements below before you submit a claim with T22.191S. Missing any one of them creates an audit vulnerability and increases denial probability. Aligning with CMS ICD-10-CM guidelines for sequela coding means meeting these standards in every affected encounter.

• Evidence of a prior first-degree burn: The record must document an earlier thermal injury at two or more sites of the right upper limb. A prior visit record, discharge summary, or explicit reference to the original burn in the current note satisfies this requirement.
• Causal linkage to the current condition: The provider must state that the current complaint is a direct result of the healed burn. Typical complaints include contracture, itching, or discoloration. Language such as “residual hyperpigmentation following a prior first-degree burn to several areas of the right arm” establishes the link.
• Confirmation that the burn has healed: The record should show that the original wound is resolved and the visit is not treating an active burn. This is what distinguishes the sequela encounter from a subsequent encounter (7th character D).
• Laterality specificity: Documentation must state right, left, or explain why laterality cannot be determined. “Right” confirms T22.191S; absence of laterality defaults to T22.199S, which carries a higher denial risk with some payers.
• Site detail: If the note names each burned site, code those sites individually instead of using the multiple-sites code.

Structured medical billing compliance requirements help the documentation from each visit map cleanly to the code on the claim. Mismatches between what the provider records and what the coder submits are where sequela claims most often fail audit scrutiny.

How to sequence a T22.191S claim, step by step

A T22.191S claim needs the residual condition first and the burn code second. Work through these steps in order on every sequela encounter.

1. Confirm that the burn has healed and today’s visit treats a late effect, not the burn itself.
2. Code the residual condition first, such as L90.5 for a documented scar.
3. Add T22.191S second, after checking first degree, right side, and multiple sites the note does not name.
4. Add an external cause code for the source of the burn, also with 7th character S, if your state or payer requires external cause reporting.
5. Leave out T31 extent codes, because the guidelines bar T31 and T32 on sequela claims.

Payer requirements and common claim denial reasons

T22.191S claims face a specific set of denial patterns that differ from those on active-injury codes. Sequela coding needs a documented history and an explicit causal link, so payers have more grounds to question these claims than initial-encounter burn codes. Understanding denial management workflows for injury sequela codes helps billers prevent rejections before submission.

Review the full list of denial codes used in medical billing to map common CARC codes to the scenarios above. Then build payer-specific worklists for injury sequela rejections. For practices experiencing repeat T22.191S denials, cross-referencing clean claim requirements by payer before resubmission cuts the correction cycle significantly.

How Pabau keeps T22.191S sequela claims clean

A sequela claim depends on notes written months apart. The original burn visit holds the degree, side, and sites, while the sequela visit holds the causal link. When those records sit in separate systems, coders have to rebuild the history before they can assign T22.191S.

Pabau keeps the original burn notes and the sequela visit in the same patient record. Coders can check degree, laterality, and site against the first encounter before they code. Through Pabau’s claims software for billers, practices then submit claims electronically via the Claim.MD integration.

The result is a sequela claim that matches its source documentation, so fewer claims come back for laterality or degree mismatches.

Reduce ICD-10 claim denials with Pabau

Pabau keeps burn history and sequela notes in one patient record, and you submit claims electronically through the Claim.MD integration. See how your practice can cut avoidable sequela rejections.

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Conclusion

T22.191S fits only when three facts line up. The healed burn was first degree, it was on the right side, and it covered several sites the note does not name. Change any one of those and a sibling code fits better, so the decision rests on reading the original documentation closely.

Before every sequela claim, check the original burn encounter and list the residual condition first. That habit heads off the denial patterns above before they start.

Book a demo to see how Pabau keeps burn history, sequela notes, and your medical billing workflow in one place.

Continue your research

Need to understand how injury sequela denials are classified and appealed? Denial management in healthcare covers the full workflow for tracking, appealing, and preventing claim rejections across injury code categories.

Looking for a complete reference on what makes a claim payable first time? Clean claim requirements outlines the data elements payers check before adjudication, relevant to any ICD-10-CM sequela submission.

Want to understand the clearinghouse step in the ICD-10 claims process? Claim.MD clearinghouse guide explains how claims pass through a clearinghouse on their way to the payer.

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