General Surgery Coding Alert

CPT treats tissue adhesives identically to stitches or staples, allowing 12001-13160 to report wound closure/repairs using tissue adhesives alone or in combination with other closure methods. Under Medicare guidelines, however, if the surgeon uses tissue adhesives solely when repairing a wound, 12001-13160 are inappropriate. Rather, CMS has designated HCPCS code G0168 (Wound closure utilizing tissue adhesive[s] only) to report such procedures. G0168 reimburses at a lower rate than simple repair codes. The CMS Final Rule published November 1999 said that the relative value units for G0168 were based on the value of a level-two established patient visit (99212, Office or other outpatient visit for the evaluation and management of an established patient ...) with the price of the tissue adhesive added as a practice expense.

The Final Rule stated that G0168's lower value was justified because "many of these wounds could have been closed by Steri-strips, a service that is also coded with evaluation and management, rather than a simple repair."

In addition, G0168 is bundled to all wound repair codes, and you may not report it separately if claiming a code in the 12001-13160 range for the same service date. The AMA, the American College of Surgeons and other physician groups have criticized the CMS guidelines, arguing that G0168 was introduced without consulting either the AMA or the ACS. For the meantime, Medicare payers continue to follow the CMS mandate and insist on G0168 (and lowered reimbursement) for repairs with tissue adhesives only.