What Is The Code For A Repair Of 7.9 Cm Laceration Of The Left Hand, Dorsum, With Layered Closure

Wound Repair Closure Coding Made Simple

Notice 3 important details in the wound repair written report, and you lot've got the case all sewn upwards.

by G.J. Verhovshek, MA, CPC
When coding for wound repair (closure), you lot must search the clinical documentation to make up one's mind three things:

The complexity of the repair (simple, intermediate, or complex)
The anatomic location of the wounds airtight
The length, in centimeters, of the wound closed

Each of these variables is specified in the repair CPT® code descriptors. For instance:
12013 Simple repair of superficial wounds [complexity] of confront, ears, eyelids, nose, lips and/or mucous membranes [location]; 2.6 cm to 5.0 cm [length]
12035 Repair, intermediate [complication], wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet) [location]; 12.6 cm to 20.0 cm [length]
13150 Repair, complex [complexity], eyelids, nose, ears and/or lips [location]; ane.0 cm or less [length]

Complexity Comes Start

Beginning, decide the complication of the performed repair(s). Your CPT® codebook is the definitive source, providing full definitions for each type of repair:
"Elementary repair is used when the wound is superficial; eg, involving primarily epidermis or dermis, or subcutaneous tissues without meaning involvement of deeper structures, and requires uncomplicated 1 layer closure."
Simple repairs are—every bit the proper noun indicates—fairly straightforward, and require only single-layer closure of the afflicted area. Such repairs involve merely the peel; deeper layers of tissue are unaffected. By contrast:
"Intermediate repair … require[s] i layered closure of one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia in improver to the skin (epidermal and dermal) closure."
In other words, wounds requiring intermediate repairs are deeper than those requiring simple repair. Per CPT®, some single-layer closures may qualify as circuitous repairs, if the wound is "heavily contaminated" and requires "extensive cleaning or removal of particulate matter."
When searching documentation for clues every bit to the complication of repair, statements such as "layered closure," "involving subcutaneous tissue," and/or "removal of debris," "extensive cleansing," etc., point to an intermediate repair. Lack of these details, or a statement of "single layer closure," suggests a simple repair.
Complex repairs involve wounds that are deeper and more dramatic, which may require debridement or significant revision:
"Complex repair … require[s] more than layered closure, viz., scar revision, debridement (eg, traumatic lacerations or avulsions), all-encompassing undermining, stents, or retention sutures. Necessary preparation includes creation of a limited defect for repairs or the debridement of complicated lacerations or avulsions."
An operative notation detailing such an extensive, reconstructive repair should be easily distinguished from other repair types, due to the need for procedures well beyond cleansing and suturing at one or more levels.

Second, Cull a Location Subcategory

Subsequently you've determined if the repair is unproblematic (12001-12018), intermediate (12031-12057), or complex (13100-+13153), narrow your code selection by the documented location of the wound(s) repaired. This is all-time done by referring to the CPT® code descriptors. For example, intermediate repairs are grouped into anatomic categories:

12031-12037: scalp, axillae, trunk, and/or extremities (excluding hands and feet)
12041-12047: neck, hands, anxiety, and/or external ballocks
12051-12057: confront, ears, eyelids, nose, lips, and/or mucous membranes

Third, Size Seals the Deal

Per CPT®, "The repaired wound(due south) should be measured and recorded in centimeters, whether curved, angular, or stellate [star shaped]." With this final piece of information, yous tin cull a repair lawmaking.
Example 1: For an intermediate repair (12031-12057) of a leg wound (12031-12037, extremities) measuring 10 cm, you would select 12034 Repair, intermediate, wounds of scalp, axillae, body and/or extremities (excluding hands and feet); seven.6 cm to 12.five cm.
Example two: A plastic surgeon performs a circuitous repair of a facial laceration, measuring ii.v cm. Because this is a complex repair, begin with lawmaking fix 13100-+13153. The complex repair codes are relatively precise regarding location, and differentiate between wounds of the eyelids, olfactory organ, ears, and/or lips and those of the forehead, cheeks, chin, mouth, and cervix. If the dr. documented but "facial laceration," ask for more item. For this example, assume the wound was on the patient's left cheek. This allows you lot to narrow your code choice to 13131-+13133. Because the wound was 2.5 cm long, the correct selection is 13131 Repair, circuitous, forehead, cheeks, chin, rima oris, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.five cm.
Note: Complex repair codes (unlike either the elementary or intermediate repair codes) employ add-on codes to describe wounds greater than vii.5 cm. Report as many units of the improver codes as necessary to depict the size of the wound repaired.
Returning to Example 2, the 2.five cm repair is reported 13131. If the wound had been 3.5 cm long, the proper code would be 13132 Repair, circuitous, forehead, cheeks, mentum, mouth, neck, axillae, genitalia, easily and/or feet; two.6 cm to 7.5 cm. If the wound had been ten cm long, proper coding would be 13132, describing the first seven.5 cm, and +13133 Repair, complex, brow, cheeks, chin, mouth, neck, axillae, genitalia, easily and/or feet; each additional v cm or less (List separately in addition to code for primary process) to account for the remaining 2.v cm. If the wound had been 16 cm long, proper coding would exist 13132 and 13133 10 2 (seven.5 cm + 5 cm + 3.5 cm), and and then on.

Code Multiple Repairs

Ofttimes, the clinician may repair several wounds in a single session. When this occurs, determine the proper coding for each repair individually. Then, bank check if whatever repairs of the same complexity are grouped to the aforementioned anatomic areas. If so, y'all should add together the lengths of the like wounds and report them using a single, cumulative code. "For case," CPT® says, "add together the lengths of intermediate repairs to the body and extremities." Exercise not combine wounds of different severity or those that fall within divide anatomic locations (as defined past the relevant lawmaking descriptors).
When reporting several wounds of differing severity and/or location, claim the about extensive (i.e., highest-valued) code every bit the chief service, and append modifier 59 Singled-out procedural service to subsequent repair codes. Multiple procedure reductions volition use for the 2nd and subsequent procedures (except for those procedures reported using an add-on code).
Case 3: The physician repairs iv wounds for a patient involved in a fall from a motorbike:

Uncomplicated repair, 10 cm, left arm
Intermediate repair, 12 cm, left arm
Intermediate repair, xv cm, left leg
Complex repair, 9.0 cm, left leg

There is a single uncomplicated repair, which is reported with 12004 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including easily and anxiety); seven.half dozen cm to 12.5 cm.
The complex repair is also the merely one of its type, and is coded 13121 Repair, circuitous, scalp, arms, and/or legs; ii.6 cm to 7.5 cm for the initial 7.5 cm, forth with +13122 Repair, complex, scalp, arms, and/or legs; each additional 5 cm or less (List separately in add-on to code for master procedure) for the additional 1.5 cm (7.5 cm + 1.five cm = 9 cm).
In that location are two intermediate repairs: Considered separately, y'all would report them using 12034 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and anxiety); 7.6 cm to 12.v cm and 12035 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding easily and feet); 12.half-dozen cm to 20.0 cm. Notice, however, that although these are split wounds, both require intermediate repair, and both are located inside the same anatomical category (the extremities). As such, combine the ii wounds (12 cm + 15 cm = 27 cm) to report 12036 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); xx.1 cm to 30.0 cm.
The circuitous repair is the most extensive procedure and should exist first listed. The remaining repairs are reported with modifier 59 appended. Final coding:

13121, +13122
12036-59
12004-59

Multiple procedure reductions will apply to 12036 and 12004 (simply non to the primary procedure, or + 13122).

Don't Shortchange the Medico

Detailed doc documentation is critical to determine the complexity and size of the repair(southward). Lackluster notes can dramatically bear on both coding precision and the md'due south bottom line, as the payment divergence between the various repair types is significant. For example, for a small (2.0 cm) chest wound:

A unproblematic repair (12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); two.5 cm or less) is valued at 0.84 dr. work relative value units (RVUs), for an approximate Medicare payment of $21.
An intermediate repair (12031 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and anxiety); 2.five cm or less) is valued at 2.0 physician piece of work RVUs, for an judge Medicare payment of $50.
A complex repair (13100 Repair, complex, body; 1.1 cm to ii.5 cm) is valued at three.0 md work RVUs, for an average Medicare payment of $75.

Source: RVUs and calculated average Medicare payments are from the 2022 National Medico Fee Schedule Relative Value File. Actual Medicare payments vary by geographic location. Individual payer reimbursements are adamant past contract.
Wait out for documentation that lacks relevant detail. If necessary, meet with your physicians and show them the lawmaking descriptors, and so they know precisely which details are required to lawmaking correctly (and to collect all earned payments).

Sidebar

Wound Repair: What'southward Arranged, What's Non

Wound repair (closure) may be performed with other, related procedures during the same session. Some of these related procedures may not be separately reported; others may be separately reported, or separately reported simply in specific circumstances. Here'south a quick rundown, based on CPT^® and the Medicare guidelines.
Never reported separately with wound repair/closure:

Any/all services considered role of the global surgical package (due east.g., topical anesthesia, writing orders, immediate/typical postoperative intendance, etc.) See the Surgical Parcel definition in the CPT^® Surgery Guidelines for complete details. Annotation that Medicare defines the surgical package differently than does CPT^®. Come across Medicare Claims Processing Manual, chapter 12, department 40.1.
Chemical or electrocauterization of wounds non closed
Uncomplicated ligation of vessels in an open wound
Simple exploration of nerves, blood vessels, or tendons exposed in an open wound. More complex exploration may be reported separately (see below).
For complex repairs, "cosmos of a limited defect for repairs or the debridement of complicated lacerations or avulsions"

Sometimes reported separately with wound repair/closure:

Decontamination or debridement: CPT^® specifies, "Debridement is considered a separate procedure only when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately without immediate primary closure." [emphasis added]
Wound repair does non include excision of benign (11400-11446) or malignant (11600-11646) lesions, just lesion excision may include would repair. Per CPT^®, simple repairs are ever included in lesion excision, only "Repair by intermediate or circuitous closure should be reported separately." Medicare, via National Right Coding Initiative edits, follows the same rules.

Always reported separately with wound repair/closure:

When associated with complex repairs (13100-+13153), excisional preparation of a wound bed (15002-15005), or debridement of an open up fracture or open dislocation
Complex repair of nerves, blood vessels, and tendons
Per CPT^®, "If the wound requires enlargement, extension of dissection (to determine penetration), debridement, removal of foreign body(s), ligation or coagulation of modest subcutaneous and/or muscular blood vessel(s) of the subcutaneous tissue, muscle fascia, and/or muscle, not requiring thoracotomy or laparotomy, utilise codes 20220-20103 as advisable."

G.J. Verhovshek, MA, CPC, is managing editor at AAPC.

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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 Higher of Pennsylvania and Clemson University.