# complex closure of surgical procedure



## mgord (Apr 22, 2009)

One of our general surgeons has presented me with this question: If he performs a colectomy and uses retention sutures when he closes, can he also bill a complex repair?

I am thinking no because open/close is included in the procedure. But in the Excision of Lesion section in CPT it does say "The closure of defects created by incision, excision or trauma may require intermediate or complex closure." Also the definition of complex repair does include wounds repaired with retention sutures. I initially thought that these wound repair codes applied only to integ procedures, however under the section that talks about involvement of nerves, blood vessels and tendons, it states that repair of complex wounds should be reported in addition to codes from the Nervous, Cardiovascular or Musculoskeletal systems. 
Am I just getting confused about these codes? If anyone could offer any advice or an answer to his question, I would greatly appreciate that!!

Thanks!!


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## FTessaBartels (Apr 22, 2009)

*Interesting question*

I would say "no" because the "wound" in this case is entirely created by the physician. 

I think the guidelines under complex repair are refering to trauma cases where a wound occurs as a result of trauma; and, if the surgeon needs to do repairs coded under the nervous, cardiovascular or musculoskeletal system, he may still be able to code the complex repair separately. 

F Tessa Bartels, CPC, CEMC


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## mgord (Apr 22, 2009)

I am pretty sure that I agree that he cannot bill it separately. But (because I know how his mind works) the statement: "The closure of defects created by incision, excision or trauma may require intermediate or complex closure.", makes it sound as if a defect created by either of these methods: incision, excision or trauma could require one of these closures that could be separately reported. 
That sentence doesnt seem to make this specifically for the integ codes and this is where I'm running into problems with getting him to accept my "no".


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