All the wounds repaired should be coded. If the patient had multiple lacerations of the same repair complexity on the same body part, the lengths of each wound should be added together to determine the code. A Medical Economics report provides the following example: a 5-cm cut on the left ankle and a 9-cm cut on the left calf would add up to 14 cm; code 12005 (12.6 cm to 20.0 cm) should be reported for a simple repair and code 12035 for an intermediate repair. Only repair lengths within a site can be added up. Lengths from different anatomic sites should be billed individually.
When more than one classification of wounds is repaired, the more complicated procedure must be always listed first. Modifier 51 should be added to the second procedure to indicate that multiple procedures were performed. The repair of a superficial wound that does not require sutures but is closed with adhesive strips is included in the fee for the evaluation and management (E/M) visit and should not be billed separately.
If the physician performed a deeply layered closure on the patient’s wound using staples for the method of repair, an intermediate repair code from the surgery section can be used. If the physician performed a single-layered closure only but had to perform extensive debridement in addition to the single-layered closure, therefore going above and beyond normal debridement, the intermediate repair code can be billed. A layered closure constitutes an intermediate repair and the intermediate repair code should be billed even if the physician does not specifically use the word “intermediate” in the documentation.
A complex repair code is used to bill the most complicated surgical repair that a physician will perform on the integumentary system, though complex repair excludes the excision of benign or malignant lesions. Complex repair is billed when the physician performs more than layered closure. Additionally, if a benign lesion was removed before the wound repair procedure, a minimum of two surgical codes can be billed: one for the removal and one for the repair.
Removal of sutures by the physician who originally placed them is not separately reportable since the removal is included in the initial laceration repair code. On the other hand, if the physician who removed the sutures did not place the sutures, then the suture removal would be considered part of evaluation and management (E/M) and the E/M code can be billed.
Debridement is not considered a separate procedure and is usually treated as part of the repair procedure. However, debridement can be billed if the physician performs debridement on a day other than the wound closure procedure.
Medical coding outsourcing is a practical option to negotiate the maze of laceration repair codes and guidelines.
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Experienced medical billing and coding service providers will ensure accurate coding for laceration repairs by considering the complexity, location and subcategory, size, and whether multiple repairs were performed. Comprehensive physician documentation is vital to determine the complexity and size of the repair(s). As there is a considerable difference between the payment for the various repair types, lack of proper documentation can affect coding precision and the provider’s reimbursement.
Posted by Medical Billers and Coders March 18, 2020 November 18, 2021 General Surgery Billing Services, Wound Care Billing Services