ED Coding and Reimbursement Alert

The coders laceration repair challenge is searching the physicians documentation to determine whether the repair rates a simple, complex or intermediate code description. And, once thats done, the Medical Coder must further refine the choice by the length of the wound. The correct code requires both determinations because a long wound isnt always complex; a physician can perform a simple repair on a 30-cm wound.

CPT provides some guidance about using repair codes (see CPT Repair At A Glance on page 21). But applying these codes in real-life situations requires more
information. The following steps give you what you need to clear the confusion.

1. Make the distinction: intermediate vs. simple. A simple laceration repair includes trimming or removing fatty tissue and cleaning the wound, says Mandy Storman, RHIT, CPC, a coding consultant for Health Information Services at Eastern Maine Medical Center in Bangor, Maine. Once youve determined that the repair is simple, you would refer to codes 12001* through 12021 to choose the specific code by the length of the wound.

However, according to CPT, a single-layer closure of a heavily contaminated wound that needs extensive cleaning would elevate it to an intermediate repair. For example, an ostensibly simple repair that takes a physician 30 minutes to clean because its full of glass shards would be elevated to intermediate.

2. Make the distinction: intermediate vs. complex. An intermediate repair is a multilayered closure that involves simple trimming or debridement. Layered is the critical word. For example, a 3-cm-deep wound through several layers (epidermal and fascia) that requires deep sutures would be coded 12032* (layer closure of wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.6 cm to 7.5 cm).

A complex repair includes extensive debridement within the layered closure. The word extensive is open to interpretation, so Storman offers an example. Extensive debridement might be pervasive road rash or a chainsaw laceration, with removal of particle matter and some extensive cleaning, she says. Inclusion of the term debridement in the documentation is unnecessary, providing it indicates time spent cleaning the wound and removing particle matter. CPT 2001s complex repair language also includes preparation of the wound: Necessary preparation includes creation of a defect for repairs (e.g., excision of a scar requiring a complex repair) or the debridement of complicated lacerations or avulsions. Complex repair does not include excision of benign (11400-11446) or malignant (11600-11646) lesions. For example, before repairing a jagged, contaminated laceration a physician prepares the site by making an elliptical incision around the cut and removing the devitalized or contaminated tissue.