Wiki Reporting COMPLEX closure

[dimplez]

Patient presents with forearm laceration. Surgeon extends the laceration to 1) explore, 2) finds that a tendon needs repair which is completed and then does a 3) complex repair. Submits exploration code (20103), tendon repair code (26XXX) and closure (13132). I send him a message 1) exploring is a component of the surgery - separate procedure definition, NCCI chapter policies Chpt 1 and 4; and also closure is a component - NCCI bundling edit with no qualifying requirements of override, NCCI policies Chpt 1 and 4.

Of course, his reply “we’ve always reported the closure! I extended the wound!” Did I misunderstand the guidelines??? Thoughts? Additional information and resources to send him/them please

 

[sbunting]

There is an NCCI edit with 20103 and 13132. Can't say with the other code without the full code. So without a qualifying requirement these 2 codes cannot be billed together. Just because they have "always reported the closure" does not mean it is correct or even reimbursed. Sorry not much help here!

 

[apoland]

You are correct on both accounts. 20103 is exploration without repair. The tendon repair codes by nature are going to include any type of closure UNLESS the code description, parenthetic notes or section guidelines state differently. I believe only the soft tissue excisions codes allow for complex repair to be reported seperately. Extension of the wound for access/exploration doesn't affect coding in this situation. I get the "I've always done it this way" response alot, you're not alone
-Autumn