# Layered, Intermediate, Complicated Closure, when do you use this kind of code?



## DonnaSdream (Sep 16, 2009)

I am studying for the CPC cert exam and I know that under Excision--Benign Lesions it says that Intermediate or Complex Closures should be coded separately.  But I am confused as to how far that rules extends.  Does that include anytime there is surgery when there is more than simple closure?  I can't find that stated anywhere else in the CPT book except under Benign Lesions, and reading that I can't seem to find anything that would include more than Integumentary System.  Also, I would think that in certain types of surgery it would be clear that more than simple closure is always required, so why isn't it bunded into the code? Can someone clarify this point for me, is it true all of the time, or is a more complicated closure bundled into some of the codes?  

Thanks.


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## ARCPC9491 (Sep 16, 2009)

Whenever an excision is performed, i.e. a lesion, a *simple *closure is always included. A simple closure can also be called a nonlayered closure. In this instance, only the excision code would be coded.

An immediate repair involves:
Closure of contaminated single layer wound
Layer closure (subcutaneous tissue, superficial fascia)
Removal foreign material (gravel, glass)
Routine debridement and decontamination

A complex repair is more complicated than the immediate repair, the complexity is defined by the provider, and as such, must be documented to support the complex repair. I always say, document repair was complex and why. A simple notation of "repair complex" is not going to cut it. 

Educational points: 
1) If documentation doesn't support immediate or complex repair, you are coding the excision only.
2) If there is an indication of immediate or complex repair, (as per descriptions above) you may code BOTH the excision and the repair.


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## FTessaBartels (Sep 18, 2009)

*Closure included in most surgeries*

Closure of the operative wound is included in most surgical packages. The exception to this is when intermediate or complex repair is required to close the wound created from excising a skin lesion. 

So, for example, if you are doing an appendectomy you would NOT separately code for repair the surgical wound. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## tcscclark (Oct 6, 2009)

*closure codes*

does layered closure include the subq sutures applied and exterior wound closure with steristrips would this constitute a layered closure?


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