Podiatry Coding & Billing Alert

Follow our tips to spot documentation showing the differences between simple and complex repairs.

You often come across wound closures that your podiatrist has performed but not all wound closures are equal. You are on the path to coding success if you grasp the finer points of coding these procedures by knowing how to distinguish one closure type from another. Answer these simple questions to master the three closure levels and chose the best paying codes.

1. Can you Recognize a Simple Repair?

If your podiatrist closes a foot wound that primarily involves the dermis and epidermis, then you have a simple repair. You might see mention of subcutaneous tissues, but not deep layers.

Mark the boundary: How do you know when a closure might involve subcutaneous layers but is still considered a simple repair? Your provider’s documentation is the key. According to experts, the difference is whether the wound is closed in layers or a single layer. The provider might decide to include the subcutaneous layer in the closure but does so by bringing the needle through the dermis into the subcutaneous and back. That results in a single-layer closure rather than closing the subcutaneous layer first and then the dermis/epidermis second in separate closure techniques.

Do not mistake the term “simple” to be an everyday affair, however. Simple repairs still call for a one-layer closure and should not be confused with a standard E/M procedure.

For example, if your podiatrist uses adhesive strips to close a laceration in the right foot, you will have to code that as an E/M service that you’ll report with the best-fitting choice from appropriate office visit codes 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient ...) or 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...). Most of such steri-strip applications are done by nursing staff and even if the physician applies them, they’re included in the E/M service.

If, however, your podiatrist uses sutures, staples, or tissue adhesives to close the laceration, consider it a separate procedure. For this simple repair, you should choose your code from among CPT^® codes 12001-12007 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet] ...), based on the lesion’s size.

Medicare exception: Guidelines change when your physician performs a single-layer laceration repair on a Medicare patient. You’ll report G0168 (Wound closure utilizing tissue adhesive[s] only) instead of reporting standard CPT^® codes. If your physician uses sutures instead of tissue adhesive for Medicare patients, turn back to the standard suture/repair codes.

2. What If the Repair Goes Deeper?

If your podiatrist goes any deeper than the superficial layers the documentation should indicate “intermediate repair;” it means your physician performed either a:

• Layered closure of one or more deeper layers (subcutaneous and superficial fascia/non-muscle) in addition to skin; or
• Single-layer closure of heavily contaminated wounds requiring extensive cleaning.

For reporting intermediate repair, you can choose the applicable codes from the following code group :

• 12031-12037 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet ...); or
• 12041-12047 (Repair, intermediate, wounds of neck, hands, feet and/or external genitalia ...).

Cleaning vs. repair: Most lacerations will have some degree of particulate matter removed. In order to assign an intermediate repair code, the work involved in removing the matter must be extensive and above what is considered normal removal or cleaning. Otherwise you will have to resort to E/M codes for simple wound cleaning.

Consequently, if you report a procedure as intermediate because of the contamination level and cleaning, be sure you have the documentation to back it up. Payers will want notes regarding how extensive the wound was, the level of work involved in cleaning, and the amount of time spent on the procedure. Look for any verbiage that will help describe the extra work involved. The use of words like “extensive,” “heavily contaminated,” “large,” or “copious amounts” of particulate matter or debris will all help the carrier understand that the cleaning is above and beyond that of a normal wound preparation.

Are You Looking at Extensive Wound Repair?

Complex repair procedures are more than multilayered closure and include a wide range of possibilities such as scar revision or involved debridement. Complex repair generally includes extensive undermining, stenting, or retention sutures and is very time-consuming.

If your podiatrist performs a complex repair, you can choose from among the following three codes:

• 13131 -- Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm
• 13132 -- Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm
• +13133 -- Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; each additional 5 cm or less [List separately in addition to code for primary procedure].

“If the physician engages in a secondary repair, you can bill that with code 13160 (Secondary closure of surgical wound or dehiscence, extensive or complicated),” says Arnold Beresh, DPM, CPC, of Peninsula Foot and Ankle Specialists PLC in Hampton, Va.

Caution: Look closely at the provider’s closure description and do not code by the wound description. Many providers may describe a complex wound but then close it with a simple technique.

Consider more than layers when you think it’s time to report complex repair codes. Your physician’s documentation should include notes about correcting a defect, performing extensive tissue debridement, or even creating a defect in order to repair a problem.

What it’s not: Sometimes your physician might perform lesion excision as part of a complex repair. The repair codes do not include excision, so in those situations you’ll report separate codes for the excision and repair. Excision of lesions is not included in complex repair and therefore would be coded separately. However, intermediate or complex closure of a lesion removal (benign or malignant) is not included as part of lesion removal, either. As long as the closure is intermediate or complex, you should also apply a separate charge for the closure.

Example: Your physician removes a 2 cm benign lesion (including margins) from the patient’s right heel. He closes the wound in layers after extensive irrigation and undermining of tissues. When filing the claim, you should report 13131 for the complex repair and 11422 (Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm).