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Coding tip: Know your integumentary system coding definitions

Ambulatory Surgery Reimbursement Update, November 27, 2007

Lesion excisions: An excision is a full-thickness (through the dermis) removal of a lesion, and includes a simple (non-layered) closure. If the procedure requires an intermediate closure, you should code and bill separately from the lesion excision codes(s), unless the code description or the Correct Coding Initiative (CCI) unbundling material directs otherwise.

Simple closures are non-layered: The wound is superficial and involves primarily the epidermis, dermis, or subcutaneous tissues. Medicare defines this closure as a wound involving the skin and subcutaneous tissue.

Intermediate closures are layered closures: The wound requires a layered closure of one or more of the deeper layers of subcutaneous tissue and superficial fascia, in addition to the skin closure. Medicare defines this closure as a wound involving the closure of one or more fascial layers, in addition to the skin and subcutaneous tissue. Complex closures are more than layered closures: This type of repair includes wounds that require more than layered closures, some scar revisions, some debridements, traumatic lacerations, some avulsions, and some procedures involving extensive undermining, stents, or retention sutures. The physician should state in the note that it was a complex repair or closure.

This tip is brought to you by Ellis Medical Consulting, Inc.

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