# Laceration repair - layered closure



## lphillips (Oct 19, 2010)

Laceration repair during delivery is inclusive unless extensive repair necessary, then append -22.

My question: Is extensive repair 3rd degree tear or higher? And 2nd degree or less inclusive?

How do you know where to break it? Doesn't 2nd degree require layered closure? Is that extensive because it's layered?

Thanks for any help.


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## preserene (Oct 19, 2010)

A good question. The episiotomy is included in the normal routine delivery reporting. 
The perineal lacerations are classified  like this:  first degree tear—a perineal laceration extending through the vaginal mucosa and perineal skin only; 
second degree tear—laceration extending into the perineal muscles; 
*third degree tear—laceration involving the external anal sphincter; plus the above
fourth degree tear—laceration affecting both the anal sphincter and the anorectal mucosa*. plus the above 

Basically the tissues involved in the second degree tear simulate those involved  in the regular (Medilateral) episiotomy wound, meaning upto that can be included into the normal delivery code(just as episiotomy is included).
The third degree and the forth degree definitely meets the complex/extensive repair.

 I believe that you can not equate the same type of tissue involvement in the delivery code,as you do in the routine integ repair. Why, because the episiotomy wound which involves the vaginal mucosa & the perineal muscles and the layered suture is already included in the delivery code. 
Let us see the varied openion.


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