Coding guidelines for skin laceration repair

Coding guidelines for skin laceration repair

Definition of Repair

Laceration repair used to treat tears or cut in the skin . It includes cleaning preparing and closing the wound,

3 Types of repair based on Medical coding :

          There are three types of repair.   

1.   Simple repair

2.   Intermediate repair

3.   Complex repair.

What is Simple repair (CPT code: 12001 – 12021)

          Simple repair is used when the wound is superficial; eg, involving primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures, and requires simple one layer closure.

          It include all local anesthesia and Simple repair can be billed for chemical and electro cauterization of wounds not closed

What is Intermediate repair : (CPT codes 12031 – 12057)

          It requires one layered closure of one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia in addition to the skin (epidermal and dermal) closure.” In other words, wounds requiring intermediate repairs are deeper than those requiring simple repair.

When documentation for clues as to the complexity of repair, like “layered closure, involving subcutaneous tissue,” and/or “removal of debris,” “extensive cleansing,” etc

What is Complex repair (CPT codes 13100 – 13160?)

It require more than layered closure, such as scar revision, debridement of traumatic lacerations or avulsions, extensive undermining, stents, or retention sutures. It may also include excision of a scar requiring a complex repair or debridement and repair of complicated lacerations or avulsions

Coding guidelines:

·        Code category based on the types of repair, location and size of the repair

·        If adjacent tissue transfer or rearrangement procedures performed with repair.  Repair cannot be coded separately. It included in adjacent tissue transfer or rearrangement procedures for the same lesion.

·        Additionally if debridement done with repair, repair cannot be coded separately for the same lesion

Coding guidelines for multiple repairs:

1.   Some time clinician may repair several wounds in a single session. Then, check if any repairs of the same complexity are grouped to the same anatomic areas. If same complexity of rapair grouped to same anatomic area you should add together the lengths of the similar wounds and code as single code

Example Intermediate repair, 12 cm, left arm, Intermediate repair, 18 cm, right leg

There are two intermediate repairs: Considered separately, you would report them using 12034 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm and 12035 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 12.6 cm to 20.0 cm. Notice, however, that although these are separate wounds, both require intermediate repair, and both are located within the same anatomical category (the extremities). As such, combine the two wounds (12 cm + 18 cm = 30 cm) to report 12036 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 20.1 cm to 30.0 cm.

2.    Several wounds of differing severity and/or location, code the most extensive (i.e., highest-valued) code as the primary service,less extensive repair as secondary CPT and append modifier 59  to subsequent repair codes. Multiple procedure reductions will apply for the second and subsequent procedures (except for those procedures reported using an add-on code).

Example: Simple repair, 10 cm, left arm, Complex repair, 7 cm, left leg

12004 (Simple repair) 13121 (Complex repair). Sequencing should be complex repair coded as primary procedure and simple repair coded as secondary procedure.

        13121, 120047-59

Following procedure can be reported with repair:

·        Complex repair can be coded with Excision preparation of a wound bed (15002-15005), or debridement of an open fracture or open dislocation

·        Intermediate and complex repair can be coded with Excision of benign / Malignant lesion.

·        Complex repair of nerves, blood vessels, and tendons

Steps for coding:   

• 1.   Identify types of repair
• 2.   Review correct location and cm from report
• 3.   Checks whether single type or multiple repairs.
• 4.   Add 59 modifier for multiple types of repair
• 5.   Look for include and exclude procedures