Orthopedic Coding Alert

Question: I am coding for a complex laceration repair with possible additional services. Could you run down what is included in complex laceration repair and what is separately codeable?

Wisconsin Subscriber

Answer: You’ll code complex laceration repairs with codes from the 13100 (Repair, complex, trunk; 1.1 cm to 2.5 cm) through +13153 (Repair, complex, eyelids, nose, ears and/ or lips; each additional 5 cm or less (List separately in addition to code for primary procedure)) code set. When choosing from these codes, remember that the following services are included in their respective work units:

First: You need to make sure your surgeon met the requirements of an intermediate repair, as they are required before you can decide if a complex laceration repair occurred. In addition to epidermal and dermal (skin) closure, CPT^® says an intermediate repair includes at least one of the following:

• Layered closure of one or more of the deeper layers of subcutaneous tissue and non-muscle fascia;
• Limited undermining; or
• Single-layer closure of wounds that require extensive cleaning, particulate matter removal.

Second: If the above conditions are met, you have at least an intermediate repair claim. To vault the procedure into complex classification, the surgeon must also perform at least one of the following, per CPT^®:

• Exposure of bone, cartilage, tendon, neurovascular structure.
• Debridement of any traumatic lacerations/avulsions on the wound edges.
• Extensive undermining.
• Placement of retention sutures.

What’s separately codeable? While any of the services described above will fall into the category of laceration repair, your surgeon could perform additional services during these encounters that you might report separately. These include:

• Excision of benign lesions: 11400 (Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less)
• through 11446 (Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm).
• Excision of malignant lesions: 11600 (Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.5 cm or less) through 11646 (Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm).
• Excisional wound bed preparation: 15002 (Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 sq cm or 1% of body area of infants and children) through +15005 (Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/ or multiple digits; each additional 100 sq cm, or part thereof, or each additional 1% of body area of infants and children (List separately in addition to code for primary procedure)).
• Debridement of an open fracture/dislocation.

Note: If you’re unsure if the surgeon performed one of the above services in addition to the laceration repair, be sure to check with them before coding to be sure that it is a distinctly separate service. Also, be sure to append modifier 59 (Distinct procedural service) to the lower-paying code(s) to ensure maximum allowable reimbursement.