# Excision of mass with closure/ complex repair



## dkissel (May 16, 2017)

The billing comes over marked 21933, 13101/59, 13102/59. A mass was removed the patient's flank, fine, but the surgeon has underlined this in the chart:

A direct approximation of closure was not possible without creating significant additional deformity. Extensive undermining of skin and subcutaneous tissue just above Scarpa layer was performed to decrease tension for closure. Extensive undermining was completed with cauterization... 

What should actually be billed for the closure, if anything? I don't believe it should be the 13101. Thanks for your help!


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## CodingKing (May 16, 2017)

Excision of subcutaneous soft tissue tumors includes simple and intermediate closure. The CPT guidelines do state "Extensive undermining or other techniques to close a defect created by skin excision may require a complex repair which should be reported separately" However looking at NCCI manual, its not separetely reportable.




> CHAPTER IV
> SURGERY: MUSCULOSKELETAL SYSTEM
> I.30
> 
> Closure/repair of a surgical incision is included in the global surgical package. Wound repair CPT codes 12001-13153 should not be reported separately to describe closure of surgical incisions for procedures with global surgery indicators of 000,010, 090, or MMM.



More detail in the integumantary system chapter of NCCI manual:




> CHAPTER III
> SURGERY: INTEGUMENTARY SYSTEM
> L.9
> Closure/repair of a surgical incision is included in the global surgical package except as noted below. Wound repair CPT codes 12001-13153 should not be reported separately to describe closure of surgical incisions for procedures with global surgery indicators of 000, 010, 090, or MMM. Simple, intermediate, and complex wound repair codes may be reported with Mohs surgery (CPT codes 17311-17315). Intermediate and complex repair codes may be reported with excision of benign lesions (CPT codes 11401-11406, 11421-11426, 11441-11471) and excision of malignant lesions (CPT codes 11600-11646). Wound repair codes (CPT codes 12001-13153) should not be reported with excisions of benign lesions with an excised diameter of 0.5 cm or less (CPT codes 11400, 11420, 11440).


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## dkissel (May 17, 2017)

Thank you for the info!


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