The first piece of information related to repair that coders must be familiar with is that when performance of a repair is with adhesive strips only, it is not appropriate to use a repair code. Instead, utilize an appropriate E&M code. Code other methods of wound repair utilizing sutures, staples, and tissue adhesives from the appropriate classification: simple, intermediate, or complex.
Secondly, the distinctions between the three classifications of wound repair listed above (simple, intermediate, and complex) are provided below:
- Simple: 12001-12018
- for superficial wounds (epidermis, dermis, subcutaneous tissue)
- Single layer closure
- Local anesthesia included
- Chemical or electrocautery of wound not closed
- Intermediate: 12031-12057
- for deeper layers of subcutaneous or superficial fascia
- Layered closure required
- Or single layer closure when extensive removal from very contaminated wound occurs
- Complex: 13100-13153
- for wounds that need more than layered closure
- Scar revision
- Debridement
- Extensive undermining
- Stents or retention sutures
As with coding for excision of lesions, when coding wound repairs, coders will note that consideration must be given to specific variables in order to arrive at the correct code assignment. Determination of the repair classification (simple, intermediate, or complex) is the initial choice a coder must make. Then, anatomical site is the next consideration. In this step, coders will notice that the anatomical site division changes depending on the type of repair performed. It is vital that coders choose the correct type of repair and corresponding anatomical site to arrive at the accurate code range. The final variable to be determined is the size of the repair. Centimeters are the measurement used to determine the size of the repair.
Performance of more than one repair requires coders to add together the lengths of all repairs from the same classification (simple, intermediate, or complex) and located in the same anatomical site grouping to get one code. For example, if a 2 cm simple repair is done of the leg and a 3 cm simple repair is done of the trunk, then the CPT code assignment is 12002 for 5 cm total simple repair and not 12001 (leg) and 12002 (trunk).
Coders should not add lengths of different classifications of repairs nor different anatomical site groupings in order to arrive at a CPT code assignment. This means that if there are two lacerations repaired on the leg, one simple and the other intermediate, it is not appropriate to add the lengths together to assign the CPT code. Instead, assign a separate code for each repair based on length since they were of different classifications.
The use of add-on codes is a specific distinction noted in the coding of complex repairs. Each anatomical subdivision includes an add-on code to capture increased size of the repair. The add-on codes represent each additional 5 cm or less when calculating size beyond the previous code. For example, when coding a complex repair of the trunk that is 8 cm in length, a coder should assign 13101 for the repair up to 7.5 cm and then also assign the add-on code 13102 for the additional 0.5 cm to make the 8 cm total. Assign, the add-on codes as many times as necessary to capture the repair length. For example, if the complex repair of the trunk was 20 cm, use code 13101 for the initial 7.5 cm and then assign 13102 times 3 to capture the remaining 12.5 cm of the complex repair.
A final point to make regarding wound repair is that when coding for lesion removal, remember that simple repairs are included in the lesion removal code and not separately assigned.
Now, light has been shed on coding wound repairs.
About the Author
Dianna Foley, RHIA, CHPS, CCS is
OHIMA's Coding Education Coordinator. Dianna has been an HIM
professional for 20 years. She progressed through the ranks of coder,
department supervisor, and department director, to her current role as a
coding consultant. She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.
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