ED Coding and Reimbursement Alert

When a patient presents to the ED with an open wound, chances are strong that your provider will work to stop the bleeding and find a way to close the injury. In some cases, this may require consultation with a surgeon, while in others, your provider will be able to close the wound right in the ED. To code these procedures, you’ll need to know the basics of wound closure.

During their presentation at HEALTHCON Regional 2021 in Charleston, South Carolina, ED Coding Alert got the word on wound closure from Sandy Giangreco Brown, BS, CHC, RHIT, CCS, CCS-P, CPC-I, COBGC, COC, PCS, and Kim Huey, MJ, CPC, CPCO, COC, CHC, CCS-P, PCS. Here’s what they had to say.

Single Layer (Usually) Means Simple Repair

For simple repairs, the wounds involve “primarily epidermis or dermis or subcutaneous tissue without significant involvement of deeper structures,” Brown and Huey explained. Simple repairs always involve uncomplicated one-layer closures.

You’ll find new language related to the Repair (Closure) preamble in the 2022 CPT^® coding manual, adding the bolded words “Chemical cauterization, electrocauterization or wound closure utilizing adhesive strips as the sole repair material are included in the appropriate E/M code.”

Similarly, there is new language in the definition of simple repairs in 2022, with the final sentence now reading, “Hemostasis and local or topical anesthesia, when performed, are not reported separately.”

You’ll code simple repairs with the following codes, depending on encounter specifics:

• 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less) through 12007 (… over 30.0 cm)
• 12011 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less) through 12018 (… over 30.0 cm)

Intermediate Repair Must Surpass Simple Definition

For intermediate repairs, the wounds are characterized by all of the traits of simple repairs, plus “layered closure of one or more layers or heavily contaminated wound. It can be a single layer, but need extensive cleaning or removal or particulate matter,” Brown and Huey said.

You’ll code intermediate repairs with the following codes, depending on encounter specifics:

• 12031 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less) through 12037 (… over 30.0 cm)
• 12041 (Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less) through 12047 (… over 30.0 cm)
• 12051 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less) through 12057 (… over 30.0 cm)

Possible Exception Lies in Different Anatomical Areas

Wound repair closure is usually bundled into any more significant surgery that the physician performs, but in the ED, it’s coded separately if it is the only procedure your provider performs.

So, if the provider performs a 4.5 cm intermediate wound closure on a patient’s left leg — and it is the only service the provider performs — you could report 12032 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm) with modifier LT (Left side) for the service.

If the provider performs a procedure in the ED, but also performs a simple or intermediate wound closure in an area unrelated to that procedure, you might be able to code it separately, though depending on the specifics, a modifier may be required. For example, if the physician performs fracture care on a patient’s left leg and also performs intermediate wound closure on the patient’s left elbow, you might be able to code for both.

Best bet: Check with your provider if you have any questions about coding a simple or intermediate wound closure along with a surgical service.

Code Complex Repairs Separately? Maybe

Complex wound closure coding is where things get … well, complex. However, you need to study complex closure rules the most carefully, as they are the most likely to be coded in addition to a procedure in the same anatomic area.

When your provider performs a complex wound closure, you’ll choose from the following codes, depending on encounter specifics:

• 13100 (Repair, complex, trunk; 1.1 cm to 2.5 cm) through +13102 (… each additional 5 cm or less (List separately in addition to code for primary procedure))
• 13120 (Repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cm) through +13122 (… each additional 5 cm or less (List separately in addition to code for primary procedure))
• 13131 (Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm) through +13133 (… each additional 5 cm or less (List separately in addition to code for primary procedure))
• 13151 (Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm) through +13153 (… each additional 5 cm or less (List separately in addition to code for primary procedure))

There are some complexities when determining whether you can report the repair in the same site as another surgery, however.

Complex repair starts with layered closure and then gets more involved. How involved the repair gets will be the element that determines whether you might be able to report a complex repair code in addition to any other portions of the surgical package.

When you report a complex repair, be sure to document the layered closure and the extra work required for the complete closure.

Complex repairs must include “repair of wounds needing … debridement, extensive undermining, etc.,” said Brown and Huey. Necessary preparation includes creation of a limited defect for repairs or debridement of complicated lacerations or avulsions.

“This [complex closure] doesn’t include excision of benign or malignant lesions, excisional prep of a wound bed, or debridement of an open fracture or open dislocation,” they said.

Sound complicated enough? Well, the rule for complex closure was updated in 2020 — with a few new requirements. According to Brown and Huey, complex wound may involve documentation of the following:

• Exposure of bone, cartilage, tendon, or named neurovascular structure;
• Debridement of wound edges (traumatic lacerations, avulsions, etc.);
• Extensive undermining (Per CPT^® manual, “A distance greater than or equal to the maximum width of the defect, measured perpendicular to the closure line along at least one entire edge of the defect.”);
• Involvement of free margins of helical rim, vermillion border, or nostril rim; or
• Placement of retention sutures.