General Surgery Coding Alert

Apply modifier 59 for same-location, different-severity repairs Coding for wound repairs requires that you consider three variables: wound size, wound location and wound severity. To avoid confusion when reporting multiple repairs, you should concentrate on one anatomic location at a time. With this in mind, here are five tips to guide you in your code selection. 1. Be Sure Repair Codes Apply You should choose codes 12001-13160 "to designate closure utilizing sutures, staples or tissue adhesive (e.g., 2-cyanoacrylate), either singly or in combination with each other, or in combination with adhesive strips," according to CPT In short: Under CPT guidelines, if the surgeon applies tissue adhesive or places even a single stitch or staple, the wound care codes are appropriate. However, adhesive strips alone don't qualify for wound repair. If the physician closes the wound using adhesive strips only, you should not report 12001-13160. Instead, you would include closure with adhesive strips only as a part of any same-day E/M service the surgeon provides, says John F. Bishop, PA-C, CPC, MS, CWS, president of Tampa, Fla.-based Bishop & Associates. Medicare Stipulates G0168 for Tissue Adhesive If the physician only uses liquid skin adhesive (Dermabond) to close a wound, you should report G0168 (Wound closure utilizing tissue adhesive[s] only) for Medicare payers, says Terri Brame, MBA, CPC, CPC-H, principal at BEST Coders. If the physician uses sutures or staples in combination with Dermabond for repair, you should report only the appropriate laceration repair code (12001-13160). You should not report G0168 with 12001-13160, Brame says. 2. Consider Wound Severity Next, you must determine the "level" of repair the surgeon undertakes. - Simple repairs (12001-12021) involve superficial wounds that involve "primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures," according to CPT. And CPT stresses that only simple, one-layer, primary suturing is required. Physicians often refer to these as "single-layer" closures. Simple repairs include local anesthesia and chemical or electrocauterization of wounds left unclosed. - Intermediate repairs (12031-12057) involve "one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition to the skin (epidermal and dermal) closure," according to CPT. If the surgeon documents a "layered closure," you-re probably looking at an intermediate repair. Worth remembering: A single-layer closure, although usually associated with simple repair, may qualify as an intermediate repair if the wound is heavily contaminated and requires extensive cleaning or removal of "particulate matter," CPT says. - Complex repairs (13100-13160) involve more than layered closure, such as extensive undermining, stents or retention sutures. Complex repairs may be reconstructive and include creating a defect to be repaired (for instance, scar excision with subsequent closure). Such repairs, however, do not include lesion excision (see [...]