General Surgery Coding Alert

Add together repair lengths for similar wounds

Lesion excision includes simple closure, but you may be able to report more complex repairs separately in some cases--which can mean hundreds of dollars in increased payment every year.

Recognize What's Included With Excision

You should not report simple wound repairs (12001-12018) with lesion excision procedures 11400-11446 (benign) and 11600-11646 (malignant), says Michelle Logsdon, CPC, CCS-P, with Falcon Practice Management LLC in Bayville, N.J. CPT specifically states that you should include non-layered closure in lesion excision. The same guidelines stipulate, however, that defects created by excision or trauma -may require intermediate or complex closure- and that intermediate or complex repairs -should be reported separately.-

CMS Bundles More Repairs Than CPT

Medicare payers observe stricter guidelines than those that follow CPT conventions . Specifically, the National Correct Coding Initiative bundles intermediate (12031-12057) and complex (13100-13153) repairs to excision of benign lesions of 0.5 cm or less (11400, 11420 and 11440)--presumably because even complex repair of such a small wound does not increase surgeon effort appreciably.

Note: Medicare does not bundle intermediate and complex repairs of malignant lesions of 0.5 cm or less.
 
Example: The surgeon removes three lesions (0.5 cm, benign with complex repair; 0.5 cm, malignant with complex repair; and 2.0 cm, benign with complex repair) from a Medicare patient.

You can't claim separate closure for the first lesion because it is 0.5 cm or less. You can claim separate closure for the second excision, even though it is 0.5 cm or less, because it is malignant. And you may report complex repair separately with the final excision because the benign lesion measures greater than 0.5 cm.

Make it easy on yourself: Clip and save the -Excision/Wound Repair Quick Reference Chart- later in this issue to help you decide when you should report separate wound repairs.

Add Repairs of Same Type and Location

When reporting wound repairs, you should add together the lengths of repairs at each identical level of severity and classified anatomic location to arrive at a total length. In other words, CPT treats all wounds at the same level of severity and anatomic subcategory as a single, -cumulative- wound, Logsdon says.

Example: The surgeon removes two benign lesions from the patient's neck (2.0 and 3.5 cm, both of which require intermediate repair) and three malignant lesions from the right arm (0.5 cm and 1.5 cm, which require complex repair, and 2.0 cm requiring intermediate repair).

Because both repairs on the neck are of the same type (intermediate) add the lengths together (2.0 + 3.5 = 5.5 cm) to select repair code 12042 (Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.6 to 7.5 cm).

For the repairs on the arm, you should add together the lengths for the complex repairs (0.5 + 1.5 = 2 cm) and report 13120 (Repair, complex, scalp, arms and/or legs; 1.1 to 2.5 cm).

For the intermediate repair on the arm, report 12031-59 (Layer closure of wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.5 cm or less; distinct procedural service).

Adding modifier 59 to the last code signifies that the intermediate repair indicated by 12031 is separate and distinct from the complex repair (also located on the arm) indicated by 13120. Without modifier 59, many payers will bundle the intermediate repair to the complex repair of the same anatomic location.