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The CPT codes for wound repair of skin and subcutaneous tissue are classified as simple, intermediate or complex depending on the use of sutures, staples or tissue adhesives. Any one of these repair can be used for wound repair. Cpt Code 12001 is the starting cpt code used for simple repair. This CPT code 12001 is used only for repair of laceration or wound used which is superficial. The simple repair is not used for deeper wounds.
According to CPT guidelines, laceration repair codes should be reported when a provider performs a wound closure using sutures, staples, or tissue adhesives (e.g., Dermabond®) either alone, in combination with each other, or together with adhesive strips. Further, as per CPT, the repaired wound(s) should be measured and documented in centimeters, regardless of whether the repair is curved, angular, or stellate (star-shaped). TheCPT Manualclassifies laceration repair codes according to three types of repair: simple, intermediate, and complex:
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Simple Repair: CPT codes 12001 – 12021):A simple wound repair code is used when the wound is superficial, primarily involving epidermis, dermis, or subcutaneous tissues without significant involvement of deeper structures where only one layer of closure is necessary using sutures, staples, tissue adhesive, or other closure materials. Simple repair can be billed for chemical and electrocauterization of wounds not closed and include local anesthesia. Cpt Code 12001 is an example of simple repair. Simple repair is not used for deeper wound. Cpt Codes 12001-12018 are used for simple repair of superficial wounds.
Intermediate Repair: (CPT codes 12031 – 12057):An intermediate wound repair code includes the repair of a wound that, in addition to the requirements for simple repair, involves a layered closure of one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia in addition to the skin (epidermal and dermal) closure. The single-layer closure of a heavily contaminated wound that requires extensive cleaning or removal of particulate matter also may also be considered an intermediate repair. Thus, an intermediate repair may be coded if the physician performed a layered closure or a single-layered closure that required extensive debridement. The CPT codes 12031-12057 are used for intermediate repair of wounds.
Complex Repair: Complex wound which require more layered closure like debridement, scar revision or complicated lacerations etc. are included under complex repair. It involves layered suturing of torn, crushed or deeply lacerated tissue. Stents or retention sutures are also included in complex repair of wound. Cpt Code 13100-13153 is used for coding complex repair.
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Coding Simple repair CPT Code 12001
We will just check how to code simple repair with an example of CPT code 12001. The CPT code is used for wound repair of different parts of body with size fewer 2.5 cm or less. The CPT code 12001 description is given below.
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
12002 ;2.6 cm to 7.5 cm
12004 ; 7.6 cm to 12.5 cm
12005 ;12.6 cm to 20.0 cm
12006 ;20.1 cm to 30.0 cm
12007 ;over 30.0 cm
12011 Simple repair of superficial wounds of face, ears,eyelids, nose, lips and/or mucous membranes; 2.5 cmor less
12013 ;2.6 cm to 5.0 cm
12014 ;5.1 cm to 7.5 cm
12015 ;7.6 cm to 12.5 cm
12016 ;12.6 cm to 20.0 cm
12017 ;20.1 cm to 30.0 cm
12018 ;over 30.0 cm
12020 Treatment of superficial wound dehiscence; simpleclosure
12021 ;with packing
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Intermediate laceration repair CPT codes
12031 Layer closure of wounds of scalp, axillae, trunk and/orextremities (excluding hands and feet); 2.5 cm or less
12032 ;2.6 cm to 7.5 cm
12034 ;7.6 cm to 12.5 cm
12035 ;12.6 cm to 20.0 cm
12036 ;20.1 cm to 30.0 cm
12037 ;over 30.0 cm
12041 Layer closure of wounds of neck, hands, feet and/orexternal genitalia; 2.5 cm or less
12042 ;2.6 cm to 7.5 cm
12044 ;7.6 cm to 12.5 cm
12045 ;12.6 cm to 20.0 cm
12046 ;20.1 cm to 30.0 cm
12047 ;over 30.0 cm
12051 Layer closure of wounds of face, ears, eyelids, nose,lips and/or mucous membranes; 2.5 cm or less
12052 ;2.6 cm to 5.0 cm
12053 ;5.1 cm to 7.5 cm
12054 ;7.6 cm to 12.5 cm
12055 ;12.6 cm to 20.0 cm
12056 ;20.1 cm to 30.0 cm
12057 ;over 30.0 cm
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Complex Repair CPT Codes
13100 Repair, complex, trunk; 1.1 cm to 2.5 cm(for 1.0 cm or less, see simple or intermediate repairs)
13101 ;2.6 cm to 7.5 cm
+13102 ;each additional 5 cm or less (List separately inadditionto code for primary procedure)
(Use 13102 in conjunction with 13101)
13120 Repair, complex, scalp, arms, and/or legs; 1.1 cm to2.5 cm
(For 1.0 cm or less, see simple or intermediaterepairs)
13121 ;2.6 cm to 7.5 cm
+13122 ;Each additional 5 cm or less (List separately inadditionto code for primary procedure)
(Use 13122 in conjunction with 13121)
13131 Repair, complex, forehead, cheeks, chin, mouth,neck, axillae, genitalia, hands and/or feet; 1.1 cm to2.5 cm(for 1.0 cm or less, see simple or intermediate repairs)
13132 ;2.6 cm to 7.5 cm
+13133 ;each additional 5 cm or less (List separately inadditionto code for primary procedure)
(Use 13133 in conjunction with 13132)
13151 Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm
13152 2.6 cm to 7.5 cm
+13153 each additional 5 cm or less (List separately in addition to code for primary procedure)
(Use 13153 in conjunction with 13152)
13160 Secondary closure of surgical wound or dehiscence, extensive or complicated
The documentation in the report should mention the location and size of the wound including their measurement in centimeters and depth. The correct calculation of the sum of the wound lengths and the type of repair, i.e., simple, intermediate, or complex is essential for proper coding and reimbursem*nt. So, be sure with the wound repair, location and size in centimeter to code the correct CPT code for laceration repair. Most of the time the coders are unable to find out what type of repair is done. So, it is very essential the documentation should be very clear with the all these things.
RVU for CPT code 12001
| Non-Facility | Work | MP | PE | RVU | Total |
|---|---|---|---|---|---|
| 0.84 | 0.17 | 1.82 | 2.83 | $95.90 | |
| Facility | Work | MP | PE | RVU | Total |
| 0.84 | 0.17 | 0.33 | 1.34 | $45.41 |
Additional Code Information for CPT code 12001
PC/TC Indicator (26): 0 = Physician Service Codes
Multiple Procedures (51): 2 = Standard payment adjustment rules for multiple procedures apply
Bilateral Surgery (50): 0 = 150% payment adjustment for bilateral procedures does not apply
Physician Supervision: 09 = Concept does not apply
Assistant Surgeon (80,82): 1 = Statutory payment restriction for assistants at surgery applies to this procedure
Co-Surgeons (62): 0 = Co-surgeons not permitted for this procedure
Team Surgery (66): 0 = Team surgeons not permitted for this procedure
Diagnostic Imaging Family: 99 = Concept does not apply
Do not separately report wound repair CPT codes 12001-13153 to describe closure of surgical incisions for procedures with global surgery indicators of 000, 010, 090 or MMM.
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Do & Don’t for Coding laceration Repair CPT codes
Check the wound is superficial or deeper
Calculate or sum up the wound size to get a final size in Centimeter
Checkout the location of wound on body to filter the cpt codes for repair
If you, filter the above three points, you get a type of repair from first point, wound size in centimeter from second and the location of wound from third. Hence, this three key points will reach you to the correct cpt code.
Hope, you would have learnt the basic difference between wound/laceration repair CPT codes. Share the article if you liked it.
