Otolaryngology Coding Alert

Until Jan. 1, 2000, otolaryngologists and other surgeons had to use one code (11330, now deleted) to describe any complex repair of lacerations of more than 7.5 cm. Consequently, whether the surgeon repaired eight or 18 centimeters, he or she was paid the same amount. CPT 2000, however, has included four new add-on codes that should be used in such situations.

Repair, or closure, of wounds or lacerations is performed using sutures, staples or tissue adhesives. Coding for such repairs can be confusing because these procedures are categorized in three different ways: by anatomic site, the depth of the wound and the size of the repair.

Correctly Code Simple Repairs

When a wound is superficialwhich CPT defines as involving primary epidermis, dermis or subcutaneous skin tissues without significant involvement of deeper structuresits repair is considered simple. According to CPT, such repairs require one single-layer closure and include local anesthesia and electrocauterization of wounds not closed.

For simple repairs, the CPT codes differentiate between the face and the rest of the body. They also are broken down by the size of the wound or laceration being repaired:

12001simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less

120022.6 cm to 7.5 cm

120047.6 cm to 12.5 cm

1200512.6 cm to 20.0 cm

1200620.1 cm to 30.0 cm

12007over 30.0 cm

12011simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less

120132.6 cm to 5.0 cm

120145.1 cm to 7.5 cm

120157.6 cm to 12.5 cm

1201612.6 cm to 20.0 cm

1201720.1 cm to 30.0 cm

12018over 30.0 cm

Note: CPT 2000 now differentiates between wounds closed with adhesive strips and those closed by other means. According to CPT, all the codes listed in this article should be used to designate wound closure utilizing sutures, staples, or tissue adhesives, either singly or in combination with each other, or in combination with adhesive strips. Wound closure utilizing adhesive strips as the sole repair material should be coded using the appropriate E/M code. In addition, Medicare says that wounds closed with tissue adhesives only (e.g., Dermabond) should be reported by using a new HCPCS codeG0168, wound closure utilizing tissue adhesive(s) onlyno other code should be used when billing Medicare.

Get the Right Code for Intermediate Repair

Intermediate repairs are more complicated. They require layered closure of one or more of the deeper layers of subcutaneous tissue and non-muscle fascia in addition to the skin closure, CPT says. Also included in this category are heavily contaminated wounds that, even though they are single-layer closures, require extensive cleaning or removal of particulate matter.

In the case of intermediate repairs, there are three anatomic areasneck, hands, feet and external genitalia; scalp axillae, trunk and/or extremities excluding hands and feet; and the face. Again, the codes are defined by the size of the wound repair:

12031layer closure of wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less

120322.6 cm to 7.5 cm

120347.6 cm to 12.5 cm

1203512.6 cm to 20.0 cm

1203620.1 cm to 30.0 cm

12037over 30.0 cm
12041layer closure of wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less

120422.6 cm to 7.5 cm

120447.6 cm to 12.5 cm

1204512.6 cm to 20.0 cm

1204620.1 cm to 30.0 cm

12047over 30.0 cm

12051layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less

120522.6 cm to 5.0 cm

120535.1 cm to 7.5 cm

120547.6 cm to 12.5 cm

1205512.6 cm to 20.0 cm

1205620.1 cm to 30.0 cm

12057over 30.0 cm

Cynthia Thompson, CPC, senior coding consultant with Gates, Moore & Co., in Atlanta, cites the following example. A 10-year-old boy has a nasty fall from his bicycle and the surgeon had to perform simple repairs on a 2.6 cm facial laceration, a 0.5 cm wound on his ear, a 2.1 cm nasal laceration, a 3.0 intermediate wound on the left side of the boys neck and a 2.0 cm intermediate wound on the right side of the neck.

The procedures billed would be listed as follows:

12042total right and left neck (intermediate, neck, 5.0 cm)

12014simple, face, ear nose, 5.2 cm total

New Add-on Codes for Complex Repairs

Finally, there are complex repairs, which are performed on complicated wounds such as scar revisions, debridements, extensive underminings, stents or retention sutures. According to CPT, the complex repair may include creation of the defect and necessary preparation for repairs or the debride-ment and repair of complicated lacerations and avulsions.

Complex repairs are defined using four anatomical sites: trunk; scalp, arms and legs; forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and feet; and eyelids, nose, ears and lips. As with simple and intermediate repairs, the anatomic site is further broken down by the size of the wound or laceration being repaired.

Until this year, the repair of wounds over 7.5 cm had to be billed using code 13300 (now deleted). In CPT 2000, however, four new add-on codes13102, 13122, 13133 and 13153have been included.

The following CPT codes (including the four new add-on codes) should be used for complex repairs:

13100repair, complex, trunk; 1.1 cm to 2.5 cm

131012.6 cm to 7.5 cm

13102each additional 5 cm or less (list separately in addition to code for primary procedure)

13120repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cm

131212.6 cm to 7.5 cm

13122each additional 5 cm or less (list separately in addition to code for primary procedure)

13131repair, complex, forehead, cheeks, chin, mouth, neck axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm

131322.6 cm to 7.5 cm

13133each additional 5 cm or less (list separately in addition to code for primary procedure)

Note: For 1.0 cm or less in the preceding three anatomic categories, see simple or intermediate repairs.

13150repair, complex, eyelids, nose, ear, and/or lips;
1.0 cm or less

131511.1 cm to 2.5 cm

131522.6 cm to 7.5 cm

13153each additional 5 cm or less (list separately in addition to code for primary procedure)

The four new add-on codes are used as follows: The code that precedes them in the book (a 2.6 cm to 7.5 cm code) would be billed first, followed by the add-on code. When reporting wound closures, the size of the repairs in the same category (simple, complex or intermediate) are added together and coded according to anatomic site, with every additional five centimeters of all the repairs in the same anatomic category billed with another unit of the appropriate add-on code.

Otolaryngologists should remember that the lengths added together must be in the same classification and the same anatomic site grouping, Thompson says. For example, do not add together intermediate and complex closures or repairs of the face and the extremities.

Note: Wound repair differs from excision of lesions because the total size of multiple lesions in the same category of anatomic site is not combined.

Documentation Must Reflect Level of Repair

As is always the case when billing for procedures, the documentation contained in the operative report must reflect the level of repairs that are performed. Further, the depth of the repair should be documented in simple terms and include the size of the laceration for each closure.

Occasionally, however, otolaryngologists fail to document the depth, length or even the number of repairs they perform. For example, if the otolaryngologist writes only repair of multiple lacerations, then only the lowest level repair in any given category may be billed.

In addition, if the surgeon indicates that he or she performed a plastic repair, coders cannot assume this was a complex repair. Instead, they need to get more information about the procedure from the surgeon.

Finally, coders should remember to check their explanation of benefits (EOB) to make sure payment for the new add-on codes has not been reduced, says Randa Blackwell, a coding specialist with the Department of Otolaryngology at the University of Maryland in Baltimore. Add-on codes are not supposed to be subject to the multiple procedure guidelines (i.e., reduced payment) because they already are reduced and are valued as complete procedures in and of themselves.

Blackwell notes that there are more add-on codes each year, and carriers are prone to pay them incorrectly. Consequently, coders should monitor their EOBs carefully. It isnt enough these days to be careful on the front end, Blackwell says, referring to coding. You also need to carefully watch the back end (reimbursement), which can mean, among other things, carefully checking your EOB to make sure payment was received and hasnt been reduced.

Another reason to carefully check the EOB is to ensure that the correct number of units for the add-on codes has been paid. If payment for an extensive closure appears to be reduced substantially, it might be because the carrier hasnt processed all the units.