Medical Coding for Wound Repairs

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Conquering the Confusion of Coding Wound Repairs
By Rachel M. Mitchell, CPC-H

Coding wound repairs often becomes cumbersome when trying to establish the difference between simple versus intermediate and complex repairs. These minor procedures are listed in the Current Procedural Terminology book by both anatomical site and wound length.

Simple repair is defined as superficial without involvement of deeper tissues. This procedure requires only one layer of closure. Intermediate repair requires more than one layer of closure or also be a simple repair with contamination which necessitates moderate debridement. Complex repair involves extensive work and undermining of deep tissue. Debridement and decontamination are also inclusive in these problematic repairs. A diagnosis code reflecting the complicated wound repair is required as well.

In order to choose an appropriate CPT code for multiple lacerations within the same anatomical site, one must add the length of all wounds.

For example: 2 cm wound of the forehead, 1 cm wound of the lip, 1.5 cm wound of the nose, all with simple closure. The proper code to use is 12013 - Simple repair superficial wounds of the face 2.6 cm to 5.0 cm.

When multiple lacerations are in different anatomic sites, use the appropriate CPT codes and attach a –51 modifier to the secondary procedure. The –51 modifier is an indicator to a payor that multiple surgeries were executed.

For example: 2.8 cm wound of the arm requiring layered repair and a 1 cm superficial laceration of the eyelid. The proper codes to use are 12032 and 12011-51.

There are several useful tips in coding integumentary repairs:

Minor exploration of tendons, blood vessels and nerves are bundled into the repair code.

Local anesthesia and wound preparation are inclusive of the repair procedure.

The majority of laceration repairs have a 0 or 10 day global period. Any patient within the 10 day global cannot be charged for anything related to the procedure, i.e., suture removal or wound check. If a patient within the 10 day global returns to their physician for an unrelated medical problem, they may be charged. Also, if a repaired area suffers from dehiscence a charge may occur using the appropriate modifier depending on the method of correction.

If there are multiple areas with lacerations in separate anatomic sites, always list the most expensive procedure on the insurance form first. In the event that a patient, particularly a small child, requires more than local anesthesia,such as a Versed IV, it is suitable to use the procedure code for conscious sedation. A modifier –51 must be used on the secondary code to indicate the multiple tasks.

Additionally, an evaluation and management visit may be coded with a repair as long as a comprehensive exam of the body site is being completed. If a patient falls and hits his/her head and also suffers from an open wound, the physician may order a CT scan. More than likely a fundoscopic exam will also take place. A combination of these tests can rule out concussion and subdural hemorrhage. The E&M level of service must have the –25 modifier appended to it. This modifier informs the insurance company that a separate, significant service was carried out.

Ms. Mitchell is the Billing and Coding Manager for Applied Medical Systems, Inc., an accounts receivable management company in Durham, North Carolina. Ms. Mitchell has over 10 years experience in medical billing, coding and consulting. For any questions regarding the above editorial you may reach Ms.Mitchell at (919) 477-5152 or at rmitchell@ams-ncl.com.

This article is reprinted with permission from the March 2002 issue of M.D. News magazine.