General Surgery Coding Alert

Question: Based on the following note, should I bill for a complex or simple repair?

Wound repair of 3.5 cm subcutaneous laceration to palmar aspect of middle phalanx of left middle finger and palmar aspect of middle phalanx of left ring finger and palmar aspect of middle phalanx of left index finger. Distal neuro/vascular/tendon intact. Laceration linear shaped, grossly contaminated with debris, minimal bleeding noted. Anesthesia: Digital block administered with 8 mls of 1% lidocaine. Wound prep: wound requires extensive cleansing with Betadine 500 ml X 2 and removal of debris, Wound explored extensively, copious irrigation. Skin closed with 26 4-0 Ethilon using simple sutures. Patient tolerated well.

New York Subscriber

Answer:  The answer lies between simple and complex. Code this as an intermediate repair 12042 (Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 to 7.5 cm) for both fingers. You should add the repair lengths together since they are from the same classification and anatomical site, so you’ll report only one code, adding the wound lengths.

CPT^® says that you should code a single layer closure requiring extensive cleaning as an intermediate repair.