Appropriate code application for laceration repairs. depends on three variables. Of the many procedures out there, laceration repair can be a concern. What is key in coding laceration repairs effectively is using the appropriate code application. And in order to have the appropriate code application for, it depends on three variables — repair complexity, wound location and wound size.
1. Repair Complexity
CPT groups laceration repairs broadly into three categories, by extent of repair.
Simple, or single-layer, repairs (12001-12018, APC 0133) involve “primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures,” according to CPT.
Intermediate repairs (12031-12057, APCs 0133 and 0134) involve “one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition to the skin (epidermal and dermal) closure,” according to CPT. Intermediate repairs generally will involve layered closure. A single-layer closure may qualify as an intermediate repair, however, if the wound is heavily contaminated and requires extensive cleaning or removal of particulate matter.
Complex repairs (13100-13153, APCs 0134 and 0135) involve more than layered closure, such as extensive undermining, stents, or retention sutures. Extensive revision or repair of traumatic lacerations or avulsions, for example, would qualify as complex repairs. In addition, complex repairs may include reconstructive or creation of a defect to be repaired (for instance, scar excision with subsequent closure).
2. Wound Location
Within each level of repair, CPT categorizes wounds by anatomic location. For example, simple repair codes 12001-12007 apply to wounds of the neck, axillae, external genitalia, trunk, and/or extremities (including hands and feet).
3. Wound Size
After narrowing your code choice according to repair complexity and anatomic location for each wound, select a final code according to the size of the repaired wound(s). For example, simple repair of a 2-centimeter wound on the neck is reported 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. The code descriptor specifies all three variables needed to classify a wound repair: complexity (simple), location (neck), and size (2.5 cm or less).
CPT treats all repairs of the same severity and within the same anatomic classification (as specified by the wound repair code descriptors) as a single, “cumulative” wound. Therefore, you would choose one code only to describe two or more repairs of the same severity in the same anatomic category.
For instance, the surgeon repairs lacerations on both hands (3 cm and 5 cm) and the left arm (9 cm). All repairs qualify as intermediate because the physician must remove particulate matter from the wounds, in addition to simple closure. To report repair of the hand wounds, add together the individual 3-cm and 5-cm lacerations for a total size of 8 cm, and report 12044 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 7.6 cm to 12 cm. For the arm wound, select 12034 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 7.6 cm to 12.5 cm.
Wound repairs generally included debridement (cleansing and removal of devitalized tissue), unless “gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately without immediate primary closure,” according to CPT instructions. Never bundle excision of lesions, whether benign (11400-11471) or malignant (11600-11646), with laceration repair.
All wound repairs codes have a T status indicator, meaning that they are significant procedures subject to multiple procedure payment reductions.
G. John Verhovshek, MA, CPC, is director of clinical coding communications for the American Academy of Professional Coders (AAPC), the nation’s largest education and credentialing association for medical coders. AAPC provides certified credentials to medical coders in physician offices, outpatient centers and medical insurance companies. The three certifications AAPC offers are CPC, CPC-H and CPC-P and represent the gold standard certification for medical coding.