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Know guidelines and subtle differences in code descriptions for laceration repairs

JustCoding News: Outpatient, September 8, 2009

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by Dawson Ballard Jr., CCS-P, CPC

If you are like most coders, you struggle to sort through the maze of laceration repair codes and guidelines. Understanding the definitions of the different types of laceration repairs is critical to assigning the correct codes.

To code a laceration repair properly, coders must understand the definition of the procedure. The CPT Manual states that coders should report laceration repair codes when a provider performs a wound closure using sutures, staples, or tissue adhesives (e.g., Dermabond®) either alone, in combination with each other, or together with adhesive strips.

When providers only use adhesive strips—and no other repair material—to perform the wound closure, coders should not report laceration repair codes; instead they should capture these procedures with the appropriate evaluation and management (E/M) code.

The CPT Manual categorizes laceration repair codes according to three types of repairs:

  • Simple
  • Intermediate
  • Complex

CPT guidelines clearly state that the repaired wound(s) should be measured and documented using centimeters regardless of whether the repair is curved, angular, or stellate (i.e., star-shaped).

Let’s take a look at each type of repair and its associated codes.

Simple repairs

Report the simple repair codes (12001–12018) for superficial wounds that require a simple, one layer closure. Providers typically perform a simple repair when the wound primarily involves the epidermis, dermis, or subcutaneous tissues, but no deeper structures.

The simple repair codes include all local anesthesia and chemical or electrocauterization of wounds not closed. The codes are further classified by the anatomical location and length of the repair.

For example, refer to codes 12001–12007 to report simple wound repairs to the following anatomical locations:

  • Scalp
  • Neck
  • Axillae
  • External genitalia
  • Trunk
  • Extremities including the hands and feet

Code selection depends on the length of the repair. For example, assign code 12001 for a repair involving any of the aforementioned anatomical locations that are 2.5 cm or less; but report code 12002 for repairs that are 2.6 cm to 7.5 cm.

The CPT Manual also provides two additional codes:

  • 12020: Treatment of superficial wound dehiscence; simple closure
  • 12021: Treatment of superficial wound dehiscence; with packing

These codes are used when a wound closure ruptures in some way, and the provider must either repair the dehiscence using a simple repair or with wound packing.

Clinical example. A patient presents to the physician’s office with an open wound to the neck. The provider diagnoses the patient with a 7.6 cm laceration and performs a simple closure of the wound. Based on the type of repair and the documented length, assign CPT code 12004 for a simple repair of a 7.6 cm superficial wound on the neck.

Intermediate repairs

The intermediate repair codes include the repair of wounds that require a layered closure of one or more of the deeper layers of subcutaneous tissue and superficial fascia in addition to a simple repair and skin closure.

The CPT Manual also states that a single-layer closure of heavily contaminated wounds requiring extensive cleaning or the removal of particulate matter also falls under intermediate repair codes.

Like the simple repair codes, the intermediate repair codes (12031–12057) are further classified by the anatomical location and the length of the repair.

Coders should familiarize themselves with the descriptions for each laceration repair code. This is because there are only subtle differences in terminology between the descriptions for simple vs. intermediate repairs. Consider the following two examples:

  • Code 12001: Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less
  • Code 12031: Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less

Clinical example. A patient presents to the physician’s office with an open wound to the scalp. The provider diagnoses the patient with a 2.5 cm laceration and performs an intermediate closure of the wound. Based on the type of repair and the documented length, assign CPT code 12031 for an intermediate repair of a 2.5 cm wound on the scalp.

Complex repairs

A complex repair requires more than a layered closure, viz., scar revision, debridement, extensive undermining, or stents or retention sutures. It also involves necessary preparation, including the creation of a defect for repairs or the debridement of complicated lacerations or avulsions.

Note that complex repairs do not include excisions of benign or malignant lesions.

Complex repair codes (13100–13153) differ from the intermediate or simple repair codes, as there are several add-on codes that apply to these types of repairs. Consider the following two examples:

  • Code 13121: Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm
  • Add-on code 13122: Each additional 5 cm or less (Report in conjunction with code 13121)

Note the parenthetical notations for some complex repair codes. For example, code 13100 (Repair, complex, trunk; 1.1 cm to 2.5 cm) includes a parenthetical notation below the code indicating that when the repair is 1.0 cm or less, coders should ‘See simple or intermediate repairs.’

When a provider repairs multiple lacerations, CPT guidelines direct coders to add together the lengths of repairs that fall under the same classification and the same anatomic sites (meaning those that are grouped together under the same general heading in the code descriptors). Do not to add lengths or repairs from different groupings of anatomic sites or different classifications.

Clinical example. A patient presents to the physician’s office with a 2.5 cm laceration to his left hand and a 2.3 cm laceration to his right hand. Both lacerations require simple repairs.

Because these lacerations are in the same anatomical grouping and in the same classification, add the lengths together and report code 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.6 cm to 7.5).

When a provider repairs more than one classification of wounds, CPT guidelines state that coders should list the more complicated procedure as primary, the less complicated procedure as secondary, and append modifier -51 (Multiple procedures) to the secondary code(s).

Clinical example. A patient presents to the physician’s office with a 2.5 cm laceration to his left hand and a 3.2 cm laceration to his forehead. The hand laceration requires a simple repair. The forehead laceration requires an intermediate repair.

These lacerations fall under different anatomical groups and classifications, so following the guidelines, coders should report these two codes:

  • Code 12052: Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm as the primary procedure
  • Code 12001-51: Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less as secondary

Editor’s note: Dawson Ballard Jr., CCS-P, CPC, is the coding educator with Take Care Health Systems in Franklin, TN. E-mail him at dawson.ballard@takecarehealth.com.



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