ED Coding and Reimbursement Alert

Question: A patient presented with a long laceration on her leg caused by a broken pane of glass. The physician cleaned and closed the cut with sutures. It was a single-layer closure of a 13.6-centimeter wound, but the physician spent 42 minutes cleaning an extensive amount of glass out of the area before closing it. Is this a simple or intermediate repair?

Louisiana Subscriber
 
Answer: The extra work involved raises this procedure to intermediate status. Report the repair with 12035 (Layer closure of wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 12.6 cm to 20.0 cm).
 
CPT 2004 states that a simple repair "requires simple one-layer closure," which accurately describes the closure in this situation. However, CPT also reports that "single-layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair."
 
You can use repair codes when the physician closes the wounds with sutures, staples or tissue adhesives. You can also use the codes if two or more of these closure methods are used in combination on the same injury.

If adhesive strips are used with these closure methods, you should still report repair. When adhesive strips are the only closure method, choose the appropriate E/M code to report the repair.
 
Keep the below descriptions in mind when coding for wound repair (definitions for each type of closure begin on page 54 of CPT 2004):
 
Simple repairs (codes 12001-12021) close superficial wounds, usually on the epidermis or dermis, with a simple, one-layer closure. You also use simple repair codes to report local anesthesia, chemical cauterization or electrocauterization.
 
Intermediate repairs (codes 12031-12057) also close superficial wounds, but they also require layered closure of one or more of the deeper layers of subcutaneous tissue in addition to the skin closure. Also use this code to report single-layer closure of a heavily contaminated wound that requires extensive pre-closure cleaning.
 
Complex repairs (codes 13100-13160) close wounds that need more than  layered closure, such as scar revision, debridement, extensive undermining, etc. Before completing a complex repair, the doctor must either create a defect for repairs (e.g., excision of a scar requiring complex repair) or debride complicated lacerations or avulsions. The complex repair definition does not include excision of benign or malignant lesions.