CPT® Revisions Affect Burn and Skin Graft Coding

An updated classification system changes how you may apply burn treatment and skin graft codes.

CPT® 2014 incorporates a major update for coding local treatment of burns (16000-+16036) and skin grafting used for burn care (15100-+15157). Although the codes and descriptors are unchanged, a newly applied classification system affects how you’ll calculate the percentage of the body treated. This, in turn, may change how you apply the codes in a particular situation.

Lund-Browder Classification Replaces “Rule of Nines”

Codes to report local treatment of burns, and many skin grafting procedure codes, specify the total body surface area (TBSA) treated. For example, 16020 describes, “Dressing and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area).” Similarly, 15115 specifies, “Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children” [emphasis added in both descriptors].
In previous years, TBSA was calculated using the so-called “rule of nines” for adult patients, which assigned 1 percent of TBSA to the genitalia, and multiples of 9 percent to other body areas (e.g., 9 percent head, 9 percent per arm, 18 percent per leg, etc.). A modified rule of nines was applied for infants, to account for their relatively larger head (18 percent) and smaller legs (14 percent, each).
For 2014, CPT® scraps the rule of nines in favor of the more precise Lund-Browder classification method. This method is not itself new, but this is the first time it’s being used in CPT® to calculate TBSA for burns and grafts.
Whereas the rule of nines cites only general body areas (head, trunk-front, trunk-back, arms, legs, and genitalia), Lund-Browder divides the body into nearly 20 distinct areas, including neck, left and right buttocks, left and right hand, upper and lower arm, etc. Lund-Browder specifies six age groups (rather than just adult and infant) to account for changes in body makeup as individuals develop into adulthood. Collectively, these changes allow for more accurate calculation of the TBSA affected and, potentially, more exact coding.

Calculate Using Lund-Browder Classification

An easy-to-use Lund-Browder classification method chart listing TBSA percentages by body areas and patient age, may be found in the 2014 CPT® codebook. CPT® guidelines require the provider to document both the percentage of body surface involved and the depth of burn.
Looking at chart, you can quickly determine that a 6-year-old child with second-degree burns to the anterior trunk, left upper and lower arm, and left hand would have an estimated burn area of 22.5 percent TBSA (13 anterior trunk + 4 upper left arm + 3 lower left arm + 2.5 left hand = 22.5).
Tip: The above percentages would work out the same for a patient of any age. As with the rule of nines, TBSA discrepancies by patient age occur only in the head (from a high of 19 percent for patients less than 1 year old, to a low of 7 percent for adults) and thighs/legs.

ICD Continues Using Rule of Nines

Presently, the Lund-Browder classification method applies only to CPT® coding. ICD-9-CM continues to rely on the rule of nines when calculating TBSA, such as when assigning a code from category 948 Burns classified according to extent of body surface involved.
The ICD-10-CM Official Guidelines for Coding and Reporting likewise states:

 “Categories [Burns classified according to extent of body surface involved] and T32 [Corrosions classified according to extent of body surface involved] are based on the classic ‘rule of nines’ in estimating body surface involved.” But the guidelines do provide leniency by saying, “Providers may change these percentage assignments where necessary to accommodate infants and children who have proportionately larger heads than adults, and patients who have large buttocks, thighs, or abdomen that involve burns.”

John Verhovshek
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John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

No Responses to “CPT® Revisions Affect Burn and Skin Graft Coding”

  1. Mary Markowski says:

    This is the first I have heard of the rule of 9’s being replaced. I found it by accident when googling something else. 11/21/15