Wiki Layered, Intermediate, Complicated Closure, when do you use this kind of code?

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DonnaSdream

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I am studying for the CPC cert exam and I know that under Excision--Benign Lesions it says that Intermediate or Complex Closures should be coded separately. But I am confused as to how far that rules extends. Does that include anytime there is surgery when there is more than simple closure? I can't find that stated anywhere else in the CPT book except under Benign Lesions, and reading that I can't seem to find anything that would include more than Integumentary System. Also, I would think that in certain types of surgery it would be clear that more than simple closure is always required, so why isn't it bunded into the code? Can someone clarify this point for me, is it true all of the time, or is a more complicated closure bundled into some of the codes?

Thanks.:confused:
 
Whenever an excision is performed, i.e. a lesion, a simple closure is always included. A simple closure can also be called a nonlayered closure. In this instance, only the excision code would be coded.

An immediate repair involves:
Closure of contaminated single layer wound
Layer closure (subcutaneous tissue, superficial fascia)
Removal foreign material (gravel, glass)
Routine debridement and decontamination

A complex repair is more complicated than the immediate repair, the complexity is defined by the provider, and as such, must be documented to support the complex repair. I always say, document repair was complex and why. A simple notation of "repair complex" is not going to cut it.

Educational points:
1) If documentation doesn't support immediate or complex repair, you are coding the excision only.
2) If there is an indication of immediate or complex repair, (as per descriptions above) you may code BOTH the excision and the repair.
 
Closure included in most surgeries

Closure of the operative wound is included in most surgical packages. The exception to this is when intermediate or complex repair is required to close the wound created from excising a skin lesion.

So, for example, if you are doing an appendectomy you would NOT separately code for repair the surgical wound.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
closure codes

does layered closure include the subq sutures applied and exterior wound closure with steristrips would this constitute a layered closure?
 
Did you ever get a reply, I am I am wondering the same thing. Does intermediate closure include suturing and application of steri-strips? I know steri-strips alone would be an E/M service, but do steri-stips count for layer closure?
tcscclark said:
closure codes

does layered closure include the subq sutures applied and exterior wound closure with steristrips would this constitute a layered closure?
Click to expand...
I found the CPT guidelines state, "Use the codes in this section to designate wound closure utilizing sutures, staples, or tissue adhesives (eg, 2-cyanoacrylate), either singly or in combination with each other, or in combination with adhesive strips. Chemical cauterization, electrocauterization, or wound closure utilizing adhesive strips as the sole repair material are included in the appropriate E/M code.

The repair of wounds may be classified as Simple, Intermediate, or Complex. "

"Simple repair is used when the wound is superficial (eg, involving primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures) and requires simple one-layer closure. Hemostasis and local or topical anesthesia, when performed, are not reported separately."

"Intermediate repair includes the repair of wounds that, in addition to the above, require 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. It includes limited undermining (defined as a distance less than the maximum width of the defect, measured perpendicular to the closure line, along at least one entire edge of the defect). Single-layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair."

So, the provider excises a 4 cm mass and "was closed with 5 0 nylon in interrupted fashion..." "...areas were washed Steri-Strips applied dry dressing placed". For this example, there were a total of four masses excised, I only provided one as an examples as they were documented all the same. Would this qualify for the intermediate layer closure?

I am thinking that it would be applicable as an intermediate closure since there are steri-strips used in combination with the suture closure. Does anyone else agree?
 
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acf7575 said:
Did you ever get a reply, I am I am wondering the same thing. Does intermediate closure include suturing and application of steri-strips? I know steri-strips alone would be an E/M service, but do steri-stips count for layer closure?

I found the CPT guidelines state, "Use the codes in this section to designate wound closure utilizing sutures, staples, or tissue adhesives (eg, 2-cyanoacrylate), either singly or in combination with each other, or in combination with adhesive strips. Chemical cauterization, electrocauterization, or wound closure utilizing adhesive strips as the sole repair material are included in the appropriate E/M code.

The repair of wounds may be classified as Simple, Intermediate, or Complex. "

"Simple repair is used when the wound is superficial (eg, involving primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures) and requires simple one-layer closure. Hemostasis and local or topical anesthesia, when performed, are not reported separately."

"Intermediate repair includes the repair of wounds that, in addition to the above, require 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. It includes limited undermining (defined as a distance less than the maximum width of the defect, measured perpendicular to the closure line, along at least one entire edge of the defect). Single-layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair."

So, the provider excises a 4 cm mass and "was closed with 5 0 nylon in interrupted fashion..." "...areas were washed Steri-Strips applied dry dressing placed". For this example, there were a total of four masses excised, I only provided one as an examples as they were documented all the same. Would this qualify for the intermediate layer closure?

I am thinking that it would be applicable as an intermediate closure since there are steri-strips used in combination with the suture closure. Does anyone else agree?
Click to expand...
Either you are missing key information, or this closure was not layered. There is no contamination of the wound, nor debridement. I don't see where they are performing an intermediate closure. Nylon sutures are not absorbable. It is likely the provider performed a simple skin closure with 5-0 nylon and simply placed steri-strips on top. This work would be included in the skin excision.
 
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