How to code correctly for laceration repairs?

Answering a few questions will help you code correctly for laceration repairs (such as staples, sutures, or similar closure materials): 

• Was the repair limited to the epidermis, dermis, and subcutaneous tissue, or did you need to probe more deeply? 

Use simple repair codes for superficial wounds (epidermis and dermis) that need just a single-layer closure. On the off chance that the provider fixed a deeper layer of subcutaneous tissue or superficial fascia, however, then assign intermediate repair codes. Remember that these codes don't include repairs to muscles. Such cases are generally referred to as surgical specialists. 

• Where on the patient's body was the repair made? 

The codes inside the simple and intermediate categories are further characterized by the location of the injury. For instance, refer to simple repairs on the scalp, neck, axillae, external genitalia, trunk, and/or extremities, the face, ears, eyelids, nose, lips, and/or mucous membranes. 

• How long is the injury that was repaired? 

Once you've identified whether the repair is simple or intermediate and which portion of the body was injured, note the length of the wound. Providers often forget to outline this detail in their reports. 

What number of wounds were repaired? You can code for every one of them. When the patient has multiple lacerations of the same repair complexity on the same body part, coding is easy: You simply add the lengths of each wound together and choose the matching code. 

• How would I code for suture removal? 

On the off chance that a provider has placed sutures for a patient and the patient returns to the same provider for the suture removal, then the visit for the suture removal can't be charged, because the removal is included in the initial laceration repair code. 

Assigning the CPT for laceration repair depends on three things: 

• The complexity of the repair (simple, intermediate, or complex) 
• The anatomic location of the wounds closed: Simple and intermediate category codes depend on the location of the injury. For instance, 12001–12007 refers to simple repairs on the scalp, neck, axillae, external genitalia, trunk, and/or extremities. Codes 12051–12057 indicate intermediate repairs of wounds to the face, ears, eyelids, nose, lips, and/or mucous membranes. 
• The length of the wound closed (in centimeters): For example, code 12001 ought to be assigned for a repair including any of the relevant anatomical locations that are 2.5 cm or less, while codes 12002 ought to be used for repairs that are 2.6 cm to 7.5 cm. 

All the wounds repaired ought to be coded. On the off chance that the patient had multiple lacerations of the same repair complexity on the same body part, the lengths of each wound ought to be added together to determine the code. A Medical Economics report provides the accompanying example: a 5-cm cut on the left ankle and a 9-cm cut on the left calf would amount to 14 cm; code 12005 (12.6 cm to 20.0 cm) ought to be reported for a simple repair and codes 12035 for an intermediate repair. Just repair lengths inside a site can be added up. Lengths from different anatomic sites ought to be billed independently. 

When more than one classification of wounds is repaired, the more complicated procedure must be constantly listed first. Modifier 51 ought to be added to the second procedure, to indicate that multiple procedures were performed. The repair of a superficial wound that does not require sutures, however, is closed with adhesive strips is included in the fee for the evaluation and management (E/M) visit and ought not to be billed separately. 

In the event that the physician performed a deeply layered closure on the patient's wound utilizing staples for the method of repair, an intermediate repair code from the surgery section can be used. On the off chance that the physician performed a single-layered closure just however needed to perform extensive debridement notwithstanding the single-layered closure, therefore blowing away normal debridement, the intermediate repair code can be billed. A layered closure constitutes an intermediate repair and the intermediate repair code ought to be billed even if the physician does not specifically use the word "intermediate" in the documentation. 

A complex repair code is used to charge the most complicated surgical repair that a physician will perform on the integumentary system, however complex repair excludes the excision of benign or malignant lesions. Complex repair is billed when the physician performs more than layered closure. Moreover, 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. 

The American Medical Association provides the accompanying guidance on suture removal: 

Removal of sutures by the physician who originally placed them isn't separately reportable since the removal is included in the initial laceration repair code. Then again, in the event that the physician who removed the sutures didn't place the sutures, the suture removal would be considered a piece of an evaluation and management (E/M) and the E/M code can be billed. 

Debridement isn't considered a separate procedure and is generally treated as a component 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 re-appropriating is a functional alternative to negotiate the maze of laceration repair codes and guidelines. 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 imperative to determine the complexity and size of the repair(s). As there is a considerable difference between the payment for the different repair types, the absence of proper documentation can affect coding precision and the provider's reimbursement.