ED Coding and Reimbursement Alert

Question: Double check code descriptors for complex repairs

Scenario: A patient was injured in a bicycle accident and presented with lacerations on the upper lip, cheek, and thigh. Upon examination, the lip and cheek wounds appear serrated and embedded with glass. Both will require debridement, with wide excision of the serrated skin margins and extensive undermining of the dermis. The thigh wound is not deep and only involves the dermis. Initial size of the lip wound was 2.6 cm; initial size of the cheek wound was 2.8 cm; and initial size of the thigh wound was 2.7 cm.

The physician performs complex repairs to the upper lip and cheek lacerations and a simple repair of the thigh wound. Final lengths of the repaired and sutured wounds as documented in the operative report are: lip: 2.9 cm; cheek: 3.0 cm; and thigh: 2.7 cm.

North Carolina Subscriber

Answer: As noted in the laceration repair article on page XX, for complex repairs, the subclassifications are more precise than in simple and intermediate repairs. The complex repair codes include separate sections for trunk, scalp, arms and/or legs, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet, and more.

The correct code assignments are:

• 13152 (Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm)
• 13132 (Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm)
• 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.6 cm to 7.5 cm)