ED Coding and Reimbursement Alert

Question: We often code laceration repairs. How can we easily tell the difference among a simple, intermediate or complex repair?

Montana Subscriber

Answer: This is a common question from ED coders, and there are some simple guidelines you can follow:

1. Simple Versus Intermediate. A simple laceration repair includes trimming or removing fatty tissue and cleaning the wound. You would refer to codes 12001-12021 to choose the specific code by the length of the wound. Be aware that, according to CPT, a single-layer closure of a heavily contaminated wound that needs extensive cleaning would elevate it to an intermediate repair.

2. Intermediate Versus Complex. An intermediate repair is a multi-layered closure that involves simple trimming or debridement. The term layered is important. For example, you would code a 4-cm-deep wound through several layers (epidermis and fascia) that requires deep sutures as 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 undermining or debridement within the layered closure.

3. Debridement. In most cases, repair codes include debridement. If gross contamination requires prolonged cleansing or removal of a large amount of contaminated tissue, or when the physician performs debridement alone without immediate primary closure, however, CPT considers debridement to be a separate procedure.