General Surgery Coding Alert

Sometimes repairs are bundled, but sometimes not

Just as with integumentary system excisions (such as 11400-11646), you should include simple repairs (12001-12021) in all musculoskeletal excisions (for instance, 21930, Excision, tumor, soft tissue of back or flank)--at least for payers that follow Medicare guidelines.

Introductory material in the Correct Coding Initiative (CCI) specifically states, -when - lesion removal requires only - simple closure, this is included in the lesion excision and is not reported separately.-

Good news: In some cases, you may be able to report intermediate and/or complex closures with musculo-skeletal excisions.

Bad news: CCI rules for reporting intermediate and/or complex repairs with 20000-series excisions are inconsistent. And that means you-ll probably have to check the CCI edits on a case-by-case basis to determine whether you can report repairs separately.

Example: The CCI bundles intermediate repairs (12031 and 12032), and complex repairs up to 7.5 cm (13101), to 21930. You can report complex repairs larger than 7.5 cm separately.

Example 2: For subcutaneous soft-tissue excision in the shoulder (23075), CCI bundles intermediate repairs and complex repairs up to 2.5 cm (13131). For deep excision in the same area (23076), CCI bundles intermediate repairs and complex repairs up to 7.5 cm (13132)--presumably because a deep excision would require more extensive repair than a subcutaneous excision, and the -deep- code is correspondingly valued at a higher rate.

Example 3: CCI bundles intermediate repairs up to 7.5 cm (12031-12032) to 24075 (Excision, tumor, soft tissue of upper arm or elbow area; subcutaneous) and 24076 (- deep [subfascial or intramuscular]). CCI does not prevent you from reporting complex repairs, or intermediate repairs over 7.5 cm, separately with 24075 and 24076, however.

In short: Separate payment for wound repair varies by procedure for the musculoskeletal excisions and can depend on the level of repair (intermediate or complex), as well as the total repaired wound length.

Best advice: Don't take anything for granted. Check CCI on each occasion to see if you are due separate payment for wound closure with a 20000-series excision.

A final note: Because you choose a repair code by adding together the total length of the repairs in any one area, you may be able to report a repair code even if the individual repairs fall below the bundling limits prescribed by CCI--as long as the repairs- total length meets CCI requirements for separate payment.

For instance, the surgeon must repair two wounds of 1.5 cm each, using intermediate closure, following subcutaneous excision of shoulder soft tissue (23075). As explained above, CCI bundles intermediate repairs of less than 2.5 cm into 23075. But in this case, because there are two repairs totaling 3 cm (1.5 x 2), you can report the intermediate repair separately using 12032 (Layer closure of wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.6 to 7.5 cm).