Internal Medicine Coding Alert

Surprise: Some deep cuts are actually simple fixes

According to Nancy Reading, RN, CPC, director of educational services for the American Academy of Professional Coders (AAPC), you need to check if the physician's actions constitute wound repair in CPT's eyes. Otherwise, you'll report an E/M code for the service instead of a laceration repair code.

CPT 2007 has coding options for each anatomic region in the laceration repair section of CPT, but the groupings vary by complexity. For example, hands, feet, neck and external genitalia are part of the descriptor for simple repairs 12001-12007 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities ...).

However, for intermediate repairs, these regions have their own set of codes (12041-12047, Layer closure of wounds of neck, hands, feet and/or external genitalia ...)

Best bet: Read the descriptors carefully before choosing a code, to make sure you are in the proper anatomic region.

• Simple repairs are considered "superficial, involving partial- or full-thickness damage to the skin (epidermis or dermis) and/or subcutaneous tissues," says Catherine Brink, CMM, CPC, CMSCS, president of Healthcare Resource Management in Spring Lake, N.J.

Exception: If the physician uses Dermabond as the only closure material on a simple repair, CPT guidelines state the provider should report the appropriate E/M code. However, Medicare requires a different code for these closures, regardless of length.

Suppose your physician performs a single-layer repair on a Medicare patient with no particulate matter or contamination present in the wound. You should report G0168 (Wound closure utilizing tissue adhesive[s] only) for this encounter.

Check payer policy: G0168 is a valid HCPCS level-II code, and some commercial payers and Medicaid carriers recognize this code. Before coding Dermabond wound repair claims, check the insurer's policy .

• Intermediate repairs involve two layers of skin, or a single layer with particulate or contamination. You should report these repairs with 12031-12057.

Remember, depth of the repair alone does not justify increasing the complexity, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, coding analyst and coding review teacher at CodeRyte Inc., headquartered in Bethesda, Md. To code for an intermediate repair, there must be evidence of a layered closure/extensive cleaning.

Reason? The internist can close some deep subcutaneous injuries with a single-layer repair.

In this instance, you'd report 12051 (Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less) for the service.

In short: If the repairs are of the same complexity and in the same anatomic region, add the lengths of the two repairs and choose a code based on the sum. If the fixes occurred in separate regions, or if the wounds' complexities differ, report separate codes for each, Jandroep says.

Single-complexity/anatomy example: The internist makes a 2-cm simple repair on a patient's arm and a 4-cm simple repair on his chest. The complexity and anatomic region of these repairs are the same, so you would add the repair lengths and report 12002 (... 2.6 cm to 7.5 cm).

Multi-code example: A man falls off his bicycle and cuts his right hand (3 cm) and his face (1.6 cm). The internist makes single-layer repairs to each injury.

• 12002 ( ... 2.6 cm to 7.5 cm) for the hand repair.
• 12011 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less) for the face repair.

Remember: When reporting two or more wound repair codes of differing complexities, list repair codes in order of complexity -- highest first.