betsycpcp
Networker
We are the payer, and we denied 12005. The doctor's office is appealing, stating that it wasn't for closing the surgical wound, so it should be payable with modifier 59.
NCCI edits bundle 12005 (simple wound repair of hand) with multiple other procedures that were done- 26615 (open treatment metacarpal fracture), 11012 (debridement at site of open fracture), 26350 (repair of tendon). This patient had a mangled hand. After repairing bones, nerves, blood vessels, tendons, etc., they closed the laceration and billed 12005 for that. I've found statements that intermediate and complex wound repair may be separated reported with traumatic injury, but I can't find anything stating a simple repair can be separately reported when it's in the same area where the open fracture, etc is being repaired. The op report is very long and I don't have any way to copy/paste it. It doesn't go into any detail on the wound repair- just says near the end of the report that they considered amputating 2 fingers that would not be viable but decided to wait, "so we repaired the skin of the entire wound of the hand" and then placed a dressing. At the start of the report it says the wound was contaminated and they irrigated it and excised any nonviable tissue including bone--so that would be covered by 11012. In the list of procedures at the top it says "closure of hand wound, measuring 15 x 5 cm."
Is it correct to bill 12005-59 in this case or is it included? Do you have a reference that addresses this?
Thanks for any help.
NCCI edits bundle 12005 (simple wound repair of hand) with multiple other procedures that were done- 26615 (open treatment metacarpal fracture), 11012 (debridement at site of open fracture), 26350 (repair of tendon). This patient had a mangled hand. After repairing bones, nerves, blood vessels, tendons, etc., they closed the laceration and billed 12005 for that. I've found statements that intermediate and complex wound repair may be separated reported with traumatic injury, but I can't find anything stating a simple repair can be separately reported when it's in the same area where the open fracture, etc is being repaired. The op report is very long and I don't have any way to copy/paste it. It doesn't go into any detail on the wound repair- just says near the end of the report that they considered amputating 2 fingers that would not be viable but decided to wait, "so we repaired the skin of the entire wound of the hand" and then placed a dressing. At the start of the report it says the wound was contaminated and they irrigated it and excised any nonviable tissue including bone--so that would be covered by 11012. In the list of procedures at the top it says "closure of hand wound, measuring 15 x 5 cm."
Is it correct to bill 12005-59 in this case or is it included? Do you have a reference that addresses this?
Thanks for any help.