General Surgery Coding Alert

Experts reveal when to report intermediate repair codes

If you resort to simple repair codes (12001-12021) when you could easily - and more accurately - report intermediate services (12031-12057), you may be losing reimbursement and not even know it.

You can get the laceration repair coding payment you deserve by knowing when to report higher-paying intermediate laceration repairs. Use the following four expert coding recommendations to get started. 1. Look for Layer Descriptions When choosing between simple (12001-12021) and intermediate (12031-12057) repair codes, encourage your physician to use specific language. This way, you can more easily select the appropriate code, says Catherine Brink, CMM, CPC, president of HealthCare Resource Management Inc. in Spring Lake, N.J.

For example: If your physician documented a 2.2-cm superficial wound that primarily involved the epidermis, dermis or subcutaneous tissues without significant involvement of deeper structures, he probably performed a simple one-layer closure. In this case, you would report 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less).

On the other hand, if your physician performs an intermediate repair, he treats wounds that include the simple repair services but also require layered closure of one or more deeper layers of subcutaneous tissue and superficial fascia, Brink says.

Hint: Look for the key phrase, "layered closure." Other terms that may signal an intermediate repair include "deeper layers of subcutaneous and superficial (nonmuscular) fascia," "layered closure" or "deep layer suturing." 2. Get Down and Dirty to Raise Complexity Although intermediate repair usually requires layered closure, you can often report intermediate codes when your physician performs a single-layer closure of heavily contaminated, or "dirty," wounds. According to CPT guidelines, extensive debridement or cleaning of wounds as part of a repair qualifies the service as intermediate.

Your physician may forget to include the cleaning detail when documenting laceration services. Explain to your physician that omitting these details could cost him $50 per repair.

For example: A patient presents with a 7.6-cm gash on his right knee and shin. The cut contains a lot of gravel and debris. Your physician thoroughly cleans the wound before performing a single-layer repair. If she documents "Sutured 2.7-cm wound, knee/shin" and fails to include "extensive debridement," you would report 12002 (... 2.6 cm to 7.5 cm). The average fee for 12002 according to the 2004 Physician Fee Schedule is about $78. The average fee for 12032 (Layer closure of wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.6 cm to 7.5 cm) - the intermediate repair code [...]