# "Layered Closure" -Intermediate Wound Repair



## sheilacpc

Good day,

I have come across several coding questions where I am given a question regarding "layered closure" of a wound with only the size of the wound and the anatomical location, but no indication as to exactly what layer of skin and/or tissue was repaired.

The answer to the questions is "intermediate repair" and I don't understand why "layered closure" is considered an intermediate repair.  

According to CPT guidelines and CPT Assistant August 2006, the term "layered closure" ALONE just by itself does not constitute an intermediate repair, etc.   

Is there anyone out there who can provide additional information.

Thanks,

Sheila


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## banjocat

Sheila,

In the CPT book, it states; "*Intermediate *repair includes the repair of wounds that, in addition to the above, require *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."

This statement connects intermediate and layered.

Hope this is helpful for you.


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## GAcoder

*Simple or intermediate?*

If 1 or 2 stitches are at subcutaneous level is it layered repair?
I'm trying to understand exact cutoff between simple and intermediate.


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## sheilacpc

Banjocat and Deb,

Thank you for your post. It is appreciated.  I just received an email back from AHIMA's Professional Review Committee on the subject of simply stating "layered closure" to be equal to an "intermediate repair" of a laceration because there are many examples in their coding certification prep manuals whereas this is stated as correct.

AHIMA has stated that simply stating "layered closure" of a laceration is not enough documentation to support a CPT code for an intermediate repair of a laceration.

This information is also supported by what is already stated in CPT and CPT Assistant.  There is no correlation between "layered closure" and "intermediate repair in the CPT book.  In order to use the intermediate repair CPT codes, their must be documentation to show exactly what layers of tissue were repaired AND those layers must be ONE OR MORE OF THE DEEPER (emphasis on "DEEPER") LAYERS OF SUBQ TISSUES AND NON MUSCLE FASCIA.  THE EXCEPTION TO THIS WOULD BE FOR HEAVILY CONTAMINATED WOUNDS, FOREIGN BODY IN WOUNDS, ETC. AS STATED IN THE CPT BOOK.

Banjocat, based on the example that you provided, it is believed that would not be sufficient to code an intermediate repair as there is no documentation to show exactly what subq tissues were repaired, etc.---"layered closure" is not sufficient.   

Although  various coding experts have stipulated on various internet sites that layered closure means intermediate repair, this information is not in concert with CPT and CPT Assistant guidelines (which actually set the guidelines and standards for CPT coding).

HTH,

Sheila


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