Otolaryngology Coding Alert

Question: A patient presents with a 1.5-cm laceration of the ear, and the otolaryngologist performs an intermediate repair. The patient also has a 3.6-cm nose laceration that requires a simple repair. How should I report these procedures?

Connecticut Subscriber

Answer: In this case, you should report the intermediate wound separately from the simple closure. Therefore, claim 12051 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips, and/or mucous membranes; 2.5 cm or less) for the ear repair and 12013 (Simple repair of superficial wounds of face, ears,eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm) for the nose repair.

Remember: You should report these two repairs separately because they are not the same type of repair -- one (12013) is simple, and the other (12051) is intermediate. If the otolaryngologist performed two simple (or intermediate) repairs and she completed the procedures at the same anatomic area, you would add their lengths together and report one repair code. Some payers will  need to see modifier 59 (Distinct procedural service) appended to 12013, or they will bundle the simple repair into the intermediate repair.

Bonus: If the otolaryngologist uses single-layer closure to  repair a heavily contaminated wound that requires "extended cleaning and/or removal of substantial amounts of devitalized/contaminated tissue," you may be justified in reporting intermediate repairs (12031-12057), according to CPT. This caveat allows you to report intermediate codes for welldocumented single-layer repairs that are heavily contaminated -- but your documentation must include descriptive details about the procedure such as "prior to closure, the wound required the otolaryngologist to perform extensive cleaning of the site."

Answers to You Be the Coder and Reader Questions reviewed by Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC, president of New Jersey-based CRN Healthcare Solutions