tmsjuly69@gmail.com
Contributor
We received a denial from an insurance carrier for a CPT Code 12032 (Repair Intermediate Scalp/Axillae/Trunk and/or Extremeties. In 2020, there were definition changes for Intermediate and Complex Repair's. "Intermediate repair of wounds that, in addition to the above, required layered closure of one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition to the skin (epidermal and dermal) closure. It includes limited undermining.........
Our operative report says "Intermediate layered repair was performed to close large gap created by lesion removal, to maintain function in the area, to minimize pain, and to reduce tension to reduce risk of skin necrosis, infection, and wound dehiscence. Undermining was peformed with blunt dissection. Hemostasis was acheived with electrocautery. The subcutaneous tissue and dermis were closed with 4-0 vicryl. Epidermal closure was achieved with 4-0 monosof (running). The final wound length was 4 cm.
Our EHR, EMA, populated this information and we feel it should support the requirments to bill the Intermediate repair. However, we want to make sure we are compliant and add to our operative notes what is necessary.
The Insurance carrier stated, "After review of the medical records, documentation does not support CPT code 12032. As per operative report, repair procedure is not involved in superficial fascia level. Therefore, CPT code 12032 will not be reimbursed.
That being said, do you think our operative note supports this definition change or do we need to add the and superficial (non-muscle) fascia ?
Thank you
Our operative report says "Intermediate layered repair was performed to close large gap created by lesion removal, to maintain function in the area, to minimize pain, and to reduce tension to reduce risk of skin necrosis, infection, and wound dehiscence. Undermining was peformed with blunt dissection. Hemostasis was acheived with electrocautery. The subcutaneous tissue and dermis were closed with 4-0 vicryl. Epidermal closure was achieved with 4-0 monosof (running). The final wound length was 4 cm.
Our EHR, EMA, populated this information and we feel it should support the requirments to bill the Intermediate repair. However, we want to make sure we are compliant and add to our operative notes what is necessary.
The Insurance carrier stated, "After review of the medical records, documentation does not support CPT code 12032. As per operative report, repair procedure is not involved in superficial fascia level. Therefore, CPT code 12032 will not be reimbursed.
That being said, do you think our operative note supports this definition change or do we need to add the and superficial (non-muscle) fascia ?
Thank you