We had a debate in my office over laceration repair codes with multiple lacerations. The example used in the discussion was a simple repair on the forearm, and a simple repair on the thigh. One side says that we need to add the lengths together and bill one code, and the other side says that we bill two separate codes, one for each repair. Is there a right answer? Is it payer specific? Can anyone point me to where I can find a reputable definitive answer, other than the guidelines in the AMA CPT book? The guidelines say to add together wounds in the same "anatomic category". Thank you all for your input.
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Wiki Multiple Lacerations
- Thread starter bforr
- Start date
mitchellde
True Blue
In the CPT book it tells you to add the lengths together when they are the same type of repair and same identified area. Your example is two simple repairs, so same type, and one arm and one thigh so extremities is all in the same area so add the lengths
Right, that's what I thought. However, my coworkers are interpreting "same area" as meaning two on the hands, or two on the leg, not one on the arm and one on the leg. Do you know of anywhere I can get a real definitive answer? Also, I was shown this morning a copy of a claim we sent to a MCR replacement plan with 12001 and 12001-59, and both repairs were paid. This leads me to believe it is payer specific, but I can't find any good information on it.
AB87
Guru
12001
Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less
Lay Description
The physician performs wound closure of superficial lacerations of the scalp, neck, axillae, external genitalia, trunk, or extremities using sutures, staples, tissue adhesives, or a combination of these materials. A local anesthetic is injected around the wound and it is cleansed, explored, and often irrigated with a saline solution. The physician performs a simple, one-layer repair of the epidermis, dermis, or subcutaneous tissues. For multiple wounds of the same complexity and in the same anatomical area, the length of all wounds sutured is summed and reported as one total length. Report 12001 for a total length of 2.5 cm or less; 12002 for 2.6 cm to 7.5 cm; 12004 for 7.6 cm to 12.5 cm; 12005 for 12.6 cm to 20 cm; 12006 for 20.1 cm to 30 cm; and 12007 if the total length is greater than 30 cm.
This is from EncoderPro, Which is the same as the CPT Book. The CPT book says it Black and White
and the Reason why it Paid because -59 Unbundles Codes. Please be VERY Careful when Applying -59
Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less
Lay Description
The physician performs wound closure of superficial lacerations of the scalp, neck, axillae, external genitalia, trunk, or extremities using sutures, staples, tissue adhesives, or a combination of these materials. A local anesthetic is injected around the wound and it is cleansed, explored, and often irrigated with a saline solution. The physician performs a simple, one-layer repair of the epidermis, dermis, or subcutaneous tissues. For multiple wounds of the same complexity and in the same anatomical area, the length of all wounds sutured is summed and reported as one total length. Report 12001 for a total length of 2.5 cm or less; 12002 for 2.6 cm to 7.5 cm; 12004 for 7.6 cm to 12.5 cm; 12005 for 12.6 cm to 20 cm; 12006 for 20.1 cm to 30 cm; and 12007 if the total length is greater than 30 cm.
This is from EncoderPro, Which is the same as the CPT Book. The CPT book says it Black and White
and the Reason why it Paid because -59 Unbundles Codes. Please be VERY Careful when Applying -59
Last edited:
mitchellde
True Blue
exactly! Just because your claim sliped thru the electronic edits does not mean it was coded properly. You unbundled this service by billing both repairs using the 59 modifier. Medicare will not like this.
mitchellde
True Blue
Your manager is making this very difficult for you for some unknown reason. anatomical area is the area defined within the scope of the CPT code nomenclature. It does not say body part, or site specific area. The trunk is an anatomical area and the extremities is, so when the CPT descriptor puts them together it is called an anatomical grouping or area. I think your manager is trying to pin down a star here and it is not going to happen. Some things you must take on faith.