General Surgery Coding Alert

Coding for wound repairs requires that you consider three variables: wound size, wound location and wound severity. To avoid confusion when reporting multiple repairs, you should concentrate on one anatomic location at a time.

With this in mind, here are five tips to guide you in your code selection.

You should choose codes 12001-13160 "to designate closure utilizing sutures, staples or tissue adhesive (e.g., 2-cyanoacrylate), either singly or in combination with each other, or in combination with adhesive strips," according to CPT

In short: Under CPT guidelines, if the surgeon applies tissue adhesive or places even a single stitch or staple, the wound care codes are appropriate.

However, adhesive strips alone don't qualify for wound repair. If the physician closes the wound using adhesive strips only, you should not report 12001-13160. Instead, you would include closure with adhesive strips only as a part of any same-day E/M service the surgeon provides, says John F. Bishop, PA-C, CPC, MS, CWS, president of Tampa, Fla.-based Bishop & Associates.

If the physician only uses liquid skin adhesive (Dermabond) to close a wound, you should report G0168 (Wound closure utilizing tissue adhesive[s] only) for Medicare payers, says Terri Brame, MBA, CPC, CPC-H, principal at BEST Coders.

If the physician uses sutures or staples in combination with Dermabond for repair, you should report only the appropriate laceration repair code (12001-13160). You should not report G0168 with 12001-13160, Brame says.

Next, you must determine the "level" of repair the surgeon undertakes.

- Simple repairs (12001-12021) involve superficial wounds that involve "primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures," according to CPT. And CPT stresses that only simple, one-layer, primary suturing is required. Physicians often refer to these as "single-layer" closures.

Simple repairs include local anesthesia and chemical or electrocauterization of wounds left unclosed.

- Intermediate repairs (12031-12057) involve "one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition to the skin (epidermal and dermal) closure," according to CPT. If the surgeon documents a "layered closure," you-re probably looking at an intermediate repair.

Worth remembering: A single-layer closure, although usually associated with simple repair, may qualify as an intermediate repair if the wound is heavily contaminated and requires extensive cleaning or removal of "particulate matter," CPT says.

- Complex repairs (13100-13160) involve more than layered closure, such as extensive undermining, stents or retention sutures. Complex repairs may be reconstructive and include creating a defect to be repaired (for instance, scar excision with subsequent closure). Such repairs, however, do not include lesion excision (see "Here's What Wound Repair Includes -- and What It Doesn-t" on page 51 for more information).

If the suture resulting from a complex repair happens to look like a "Z" or "W," for instance, you should nevertheless stick with codes 13100-13160 rather than choose an adjacent tissue transfer code (14000-14061), Brame says.

In a nutshell: Single-layer closures are generally simple unless the physician has noted extensive wound cleansing, in which case they may be intermediate. Dual-layer closures denote intermediate repair. Extensive revision or repair of traumatic lacerations or avulsions will qualify as complex repair, Bishop says.

Be certain: If procedure notes fail to provide enough detail to determine the repair level, ask the operating surgeon for more specifics.

Because CPT assigns repair codes according to size, you must be sure that your surgeon's documentation specifically states the length as well as the depth (severity) of each repair.

When the surgeon repairs only a single wound at a given anatomic location, your code selection is simple. For instance, if the surgeon performs a simple repair of a 2-cm chest wound, you would select 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). The code descriptor specifies all three variables needed to identify would repairs: severity (simple), location (in this case, the chest or "trunk") and length (2.5 cm or less).

If the surgeon treats two or more wounds at the same location (as specified by the wound repair code descriptors), you should add together those wounds of the same severity, says Linda Martien, CPC, CPC-H, coding specialist at National Healing Inc. in Boca Raton, Fla.

Use caution: The anatomical "categories" are not identical for each repair level, so you should be careful to read code descriptors fully before assigning codes.

For instance, for simple repairs, CPT groups the scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet) together as covered by 12001-12007. For intermediate repairs, 12031-12037 describe layered wound closure on the scalp, axillae, trunk and/or extremities excluding hands and feet, while 12041-12047 apply for wound repair to neck, hands, feet and/or external genitalia. For complex repairs, the classifications are still more precise.

Coding example: Fireman Joe climbs a tree to save Ms. Baker's stranded kitty, Scratches. Unfortunately, Fireman Joe losses his balance and falls out of the tree and onto a barbed-wire fence (Scratches is fine). Fireman Joe visits the emergency department, where the surgeon provides simple repairs for three barbed-wire lacerations measuring 2 cm, 3 cm and 3 cm, respectively, on his forearm. In addition, the surgeon provides a 1-cm intermediate repair, also on the forearm.

In this case, because the simple repairs all occur in the same general location (the forearm), you should add together the lengths of all the repairs (2 cm + 3 cm + 3 cm = 8 cm) to choose a single code, 12004 (Simple repair ... trunk and/or extremities ... 7.6 to 12.5 cm).

The final repair, although occurring at the same location, is of a different severity (intermediate). Therefore, you would report it separately using 12031 (Layer closure of wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.5 cm or less).

Look to 59: In addition, you will want to add modifier 59 (Distinct procedural service) to 12004 to specify that the superficial wounds are separate and distinct from the intermediate repair 12031. Without modifier 59, payers may bundle the simple repair to the intermediate repair of the same anatomic location, Martien says.

Finally, after you have coded for all the wound repairs within a given anatomical classification, you should repeat the same steps for additional wounds at other locations.

Coding example, continued: Suppose that as a result of his fall, Fireman Joe also hit a rock and suffered a fairly severe wound near his right temple.

In this case, in addition to the wound repairs already discussed, the surgeon must also repair a complex wound, measuring 4 cm, on Fireman Joe's face. For this new location (and severity), you would choose 13132 (Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 to 7.5 cm).