In this podcast, Natalie Tornese, one of the senior solutions managers at Outsource Strategies International, talks about laceration repairs and how to code them. Outsource Strategies International is one of the leading medical billing and coding companies, focused on providing medical billing services, medical coding, as well as insurance eligibility verifications and authorizations.
Hello everyone and welcome to our podcast series. My name is Natalie Tornese and I’m one of the Senior Solutions Managers for Outsource Strategies International (OSI). I wanted to take this opportunity to talk about laceration repairs and how to code them.
About 6 million people seek treatment in emergency room for lacerations every year. The goal of laceration treatment is to repair a wound safely without increasing the risk of infection and maintaining optimal cosmetic results. Reporting wound repairs can be complex as the codes for these procedures are based on different aspects such as the anatomic site, depth of the wound and the size of the repair. Physicians repair different types of skin or tissue wounds such as abrasions, lacerations, amputations, incisions, punctures and avulsions. Wounds could be limited to one of these or can be a combination of them.
I will include some documentation to review these specific codes along with this podcast.
A laceration refers to an injury that causes a skin tear. Also referred to as a ragged wound, it may be caused by a blunt object or machinery accident. The nature of the laceration depends on the characteristics such as angle, force, depth, or object and some wounds can be real serious, reaching as far as deep tissue and leading to serious bleeding.
Laceration repair codes should be reported when a provider performs a wound closure using sutures, staples, or tissue adhesives like Dermabond®, either alone or in combination with each other, or together with adhesive strips. As per CPT guidelines, the repaired wound(s) should be measured and documented in centimeters, regardless of whether the repair is curved, angular, or stellate.
A simple repair is coded using codes 12001 – 12021. A simple wound repair code is used when the wound is superficial, primarily involving epidermis, dermis, or subcutaneous tissue without significant involvement of deeper structures where only one layer of the closure is necessary using sutures, staples, tissue adhesive, or other closure materials. A simple repair can be billed for chemical and electrocauterization of wounds not closed and also include local anesthesia.
An intermediate repair is coded using 12031 – 12057. An intermediate wound repair code includes the repair of a wound that, in addition to the requirements for simple repair, involves a layered closure of one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia in addition to the skin (epidermal and dermal) closure. The single-layer closure of a heavily contaminated wound that requires extensive cleaning or removal of particulate matter also may be considered as an intermediate repair. An intermediate repair may be coded if the physician performed a layered closure or a single-layered closure that required extensive debridement.
A complex repair is coded using CPT codes 13100 – 13160. This includes repairs that require more than layered closure, such as scar revision, debridement of traumatic lacerations or avulsions, extensive undermining, stents, or retention sutures. It may also include excision of a scar requiring a complex repair or debridement and repair of complicated lacerations or avulsions.
There are several tips to correctly code laceration repairs.
- Assigning the CPT code for laceration repair depends on these three things:
- The complexity of the repair (simple, intermediate, or complex). The anatomic location of the wounds closed: simple and intermediate category codes depend on location of the injury. For example, 12001–12007 refer to simple repairs on the scalp, neck, axillae, external genitalia, trunk, or extremities. Codes 12051–12057 indicate intermediate repairs of the wounds of the face, ears, eyelids, nose, lips, and mucous membranes.
- The length of the wound closed (in centimeters): For example, code 12001 should be assigned for a repair involving any of the relevant anatomical locations that are 2.5 cm or less, while the code 12002 should be used for repairs that are 2.6 cm to 7.5 cm.
- All the wounds repaired should be coded. If the patient had multiple lacerations of the same repair complexity on the same body part, the lengths of each wound should be added together to determine the code. Only repair lengths within a site can be added up. Lengths from different anatomic sites should be billed individually.
- When more than one classification of wounds is repaired, the more complicated procedure must always be listed first. Modifier 51 should be added to the secondary procedure to indicate that multiple procedures were performed.
- The repair of a superficial wound that does not require sutures but is closed with adhesive strips, is included in the fee for the E/M visit and should not be billed separately.
- If the physician performed a deep-layered closure on the patient’s wound using staples for the method of repair, an intermediate repair code from the surgery section can be used. If the physician performed a single-layered closure but only had to perform extensive debridement in addition to the single-layered closure, therefore going above and beyond the normal debridement, the intermediate repair code can be billed.
- A layered closure constitutes an intermediate repair and the intermediate repair code should be billed even if the physician does not specifically use the word “intermediate” in the documentation.
- A complex repair code is used to bill the most complicated surgical repair that a physician will perform on the integumentary system, though this excludes excision of benign or malignant lesions. Complex repair is billed when the physician performs more than layered closure. Additionally, if a benign lesion was removed before the wound repair procedure, a minimum of two surgical codes can be billed: one for the removal and one for the repair.
If repairs include deeper structures which are nerves, blood vessels and tendons, refer to the appropriate anatomic system selection of your CPT manual for correct coding. The repair of these associated wounds will be included in the primary procedure unless it qualifies as a complex repair, in which case modifier 59 would apply.
Suture removal, removal of sutures by the physician who originally placed them is not separately reportable. This is included in the initial laceration repair code. On the other hand, if the physician who removed the sutures did not place the sutures, then the suture removal would be considered part of E/M code and the E/M code only can be billed.
Debridement is not considered as a separate procedure and is usually treated as part of the repair procedure. However, debridement can be billed if the physician performs debridement on a day other than the wound closure procedure.
Comprehensive physician documentation is vital to determine the complexity and size of the repair(s). As there is considerable difference between the payment for the various repair types, always remember that the lack of proper documentation as well as the thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement of the procedures performed.
Thank you for listening!