General Surgery Coding Alert

Extensive debridement can change everything.

You may think that coding for simple or intermediate wound repair is straightforward, but do you know what to do if your general surgeon repairs two distinct sites or faces a highly-contaminated field?

If you don’t, you could be making a $195 mistake. Read on to make sure you capture all the pay your surgeon deserves for simple and intermediate laceration repairs. 

Tip 1: Identify Wound Depth

To pick the proper code family, you first have to know the wound depth and type of closure your surgeon performed. You can get there, in most cases, by distinguishing the following two scenarios:

• Simple: Wound repair using one-layer closure involving only epidermis, dermis, or limited subcutaneous tissues without significant deep-structure involvement (12001-12018, Simple repair of superficial wounds …)

• Intermediate: Wound repair using multilayered closure involving deeper layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition to the skin (epidermis and dermis) (12031-12057, Repair, intermediate, wounds of …)

Tip 2: Zero In on Site and Length

Once you get to the proper code family for simple or intermediate repair, you’ll pick the specific code based on the anatomic site and repair length. 

For instance: A single layer closure involving dermis and epidermis of the scalp would require one of the following codes, depending on the repair length: 

• 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
• 12002 — … 2.6 cm to 7.5 cm
• 12004 — … 7.6 cm to 12.5 cm
• 12005 — … 12.6 cm to 20.0 cm
• 12006 — … 20.1 cm to 30.0 cm
• 12007 — … over 30.0 cm

The other simple repair sites of various lengths include 12011-12018 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes …).

Similarly, you’ll find intermediate repair codes organized by site and repair length, as follows:

• 12031-12036 — Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet) …
• 12041-12047 — Repair, intermediate, wounds of neck, hands, feet and/or external genitalia …
• 12051-12057 — Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes …

Tip 3: Add Repair Lengths — Sometimes

What if your surgeon repairs multiple lacerations for the same patient on the same day — does each repair warrant its own code?

Maybe. If the repairs involve different depths (intermediate versus simple) and/or different anatomic sites represented by different codes, you should separately report the repairs.

For instance: Your surgeon repairs a 2.0 cm laceration of the scalp (dermis and epidermis), and a 3.4 cm laceration of the scalp involving multi-layer closure. Report the service as 12001 and 12032 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.6 cm to 7.5 cm).

Alternate: If both closures in the prior example were simple, you should not report 12001 for the 2.0 cm laceration plus 12002 (…2.6 cm to 7.5 cm) for the 3.4 cm laceration. Instead, you should code for 2.0 cm + 3.4 cm = 5.4 cm simple repair, scalp, which is a single unit of 12002.

Pointer: If the repairs involve anatomic sites that represent different CPT® codes (such as neck versus lip), you can’t add the repair length for a single code. Pay attention to code body groupings, because these may change according to the repair class. For instance, CPT® includes hands, feet, and/or extremities in the same anatomic site for simple repairs, but exclude hands and feet from intermediate repair codes for extremities.

Tip 4: Consider Extensive Debridement

You should be aware that you might find an exception to the “single-layer closure = simple repair” rule.

“An exception to this single-layer rule of thumb is single-layer closure of heavily contaminated wounds that required extensive cleaning or removal of particulate matter,” observes Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians. “In that situation, the repair may be considered ‘intermediate,’ even though it only involved single-layer closure.”

For example: Your surgeon performs laceration repair for a cut that the patient received from broken glass. The laceration is 4.5 cm long on the right thigh. The surgeon found glass shards interspersed in the wound, and documented an additional 35 minutes spent removing pieces of embedded glass. After the debridement, the surgeon closed the wound with a single layer of sutures. 

Earn $194.87 more: If your surgeon didn’t document the extensive debridement, you would code the service as 12002, which pays $110.48 (National non-facility amount, conversion factor 35.7547). But factoring in a documented extensive debridement, you could report 12032, which pays $305.35 (National non-facility amount, conversion factor 35.7547).