Wiki Complex closure changes

[Sarahp941]

My Providers are having a hard time adjusting to the new guidelines for Complex closures. We understand the new "classification" of what extensive undermining is defined as, but I think there is a lot of wishy-woshy information circulating from other coding perspectives, that are becoming confusing. I have a case we performed this morning and would like some feedback. Due to the width measurements, a complex closure wouldn't be appropriate as you cannot undermine that large. But because it's a MM and it took the provider almost 20mins, how is the Provider to get "credit" for the work performed. Thanks in advance for any feedback and helpful guidance. Everyone here is greatly appreciated!

Case Summary:
Location (A): right superior upper back
Preop Size: 1.4 cm x 0.8 cm
Margin: 1 cm
Total Excised Diameter: 3.4 x 2.8 cm
Procedure: Excision - Fusiform
Final Wound Length: 7.3 cm
Repair Type: ?

 

[CatchTheWind]

Are you sure the surgeon took a 1 cm margin on every side? That sounds really large.

If so, it looks like you'll have to bill for intermediate. The way he will get "credit for the work performed" is that he will be billing for a larger wound than he would otherwise have done.

 

[Sarahp941]

Are you sure the surgeon took a 1 cm margin on every side? That sounds really large.

If so, it looks like you'll have to bill for intermediate. The way he will get "credit for the work performed" is that he will be billing for a larger wound than he would otherwise have done.

Yes, unfortunately the lesion was oddly shaped and invasive. Just a hot mess, which is why it took longer. So in her mind, billing an intermediate repair doesn't equal the work performed. I do explain (in great detail) to my Providers that I will only code for the service rendered, based on documentation. Do you think in these specific scenarios that it would be appropriate to use 22 modifier on the closure?