General Surgery Coding Alert

The February 2005 edition of General Surgery Coding Alert contained an error on page 12 ("CMS Puts the Squeeze on Modifier -59 Claims").

The "Unjustified unbundling" example states, "the patient falls and receives three lacerations on his right forearm, including two wounds totaling 5 cm requiring layered closure and a single wound of 2 cm requiring simple repair. In this case, because the simple closure occurs at the same anatomical location as the layered closures, you may not report the simple closure separately."

In fact, you can report each separately, using 12032 (Layer closure of wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.6-7.5 cm) for the intermediate repairs and 12001-59 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less; Distinct procedural service) for the simple repair. You must append modifier -59 to the less extensive repair code (12001).

Although the three wounds occur at the same anatomic location (the right forearm), and more extensive wound repairs always bundle less extensive wound repairs, the wounds in this example are all separate and distinct, says Jan Rasmussen, CPC, AGS-GI, ACS-OB, president of Professional Coding Solutions in Eau Claire, Wis. The National Correct Coding Initiative edits bundling wound repair codes are designed to prevent providers from reporting less extensive and more extensive wound repairs for the same wound.

For example, you wound not report both a complex and simple repair code for repair of the same 7.5-cm laceration of the face. Instead, you would only report the more extensive procedure (for example, 13132, Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 to 7.5 cm).