CPT CORNER
Dog-bite stats warrant awareness of wound-repair coding
“CPT Corner” is designed to provide general
information, available at the time of publication, regarding various coding, billing and
claims issues of interest to plastic surgeons.
ASPS is not responsible for any action taken
in reliance on the information contained in
this column.
by j. eric lomax, md
N
ational Dog Bite Prevention Week is
May 17-21. The unfortunate need
for such a week is evidenced by
the statistic that 4.5 million people in the
United States are bitten by dogs each year.
Twenty percent of those bites require medical
attention – 27,000 of which require reconstructive surgery, according to the American
Veterinary Medical Association. Roughly
1,000 people in this country require emergency care for a dog bite each day, according
to dogsbite.org.
This installment of CPT Corner reviews
the steps necessary to correctly report laceration-repair codes (though not the more
complicated repairs such as skin grafting
or flaps). The first step is to determine which
one of the three repair types was used.
Simple repair: Wounds that require simple one-layer closure or suturing, whether
skin sutures or buried sutures. It’s used for
superficial wounds of the epidermis, dermis
or subcutaneous tissue without significant
involvement of deeper structures.
Intermediate repair: Wounds that
require closure of one or more of the deeper
layers of subcutaneous tissue and superficial
(non-muscle) fascia, in addition to the skin
closure described under simple repair or a
16 April/May 2015 Plastic Surgery News
single-layer closure of heavily contaminated
wounds requiring extensive cleaning or
removal of particulate matter, is included
under intermediate repair – including copious or extensive irrigation and removal of
dirt, glass shards, oil or grease.
Complex repair: Wounds requiring layered closures and additional treatment such
as, but not limited to, extensive undermining
and debridement of wounds prior to closure.
The second step is to identify the repair
site or sites. CPT codes are categorized by
body site, so it’s important to review the
code descriptors carefully. Remember there
are subtle differences in the body site
descriptions between the simple, intermediate and complex repair code sets.
The third step is to identify the length of
the repaired wound in centimeters. Code
selection depends on the length of the repair
and CPT code descriptors include the length
of the repair, in centimeters.
If the wound is documented in inches
instead of centimeters, follow these conversion tips:
■ 1 inch = 2.5 cm
■ 1 inch to 2 15/16 inches = 2.6 to 7.5 cm
■ 3 to 4 15/16 inches = 7.6 to 12.5 cm
■ 4 15/16 to 7 7/8 inches = 12.6 to 20.0 cm
■ 7 15/16 to 11 13/16 inches = 20.1 to 30.0
cm
■ 11 14/16 inches = over 30.0 cm
Wound location, complexity and length are
all essential for proper coding. If not documented by the provider, the coding may
default to the lowest level for the category
listed – or be denied completely.
The final step requires answering the
following questions:
1. Were the wounds in the same anatomical code group or multiple code groups?
mented 4.2 cm laceration to the scalp undergoes a documented simple repair of the nose
laceration and a documented intermediate
repair of the scalp wound.
2. Were the wounds repaired using the
same technique (simple, intermediate or
complex repair)?
Accurate coding
12032
Repair, intermediate wounds of
scalp; 2.6 to 7.5 cm
For wounds in the same anatomical code
group and closed by the same technique, the
lengths of the wounds repaired should be
added together and only one CPT code
assigned.
Example: A patient with a documented
2.5 cm laceration on the face and a 2.5 cm
laceration of the ear are both repaired with a
documented simple closure. The face and
ear are in the same CPT code group (see coding tables, below), so the repair lengths
should be combined. Simple repair of superficial wounds of face, ears, eyelids, nose lips
and/or mucous membranes is group 120XX.
In this example, the combined length of all
repairs is 5.0 cm, so code 12013 – 2.6 cm to
7.5 cm – is assigned.
For repairs from different anatomic sites
or different classifications (simple, intermediate and complex), it’s appropriate to report
codes for each repair.
Example: A patient with a documented
2.5 cm laceration on the nose and a docu-
12011
Simple repair, wounds of nose;
2.5 cm or less
Remember to sequence the most complicated repair as the primary procedure, followed by the lesser complicated repair(s).
It’s also important to note that wound
closures utilizing adhesive strips, such as
Steri-Strips or butterfly bandages, as the sole
repair material, are not simple repairs. They
should be coded using the appropriate E/M
code.
Debridement performed in conjunction
with wound repairs are not coded separately
unless the documentation specifies that
gross contamination requires prolonged
cleansing or when appreciable amounts of
devitalized tissue is removed.
Remember accurate coding will reduce
billing errors. A simple $10 coding error per
patient would have a cumulative cost to the
health-care system of more than $8 million
per year. PSN