Part B Insider (Multispecialty) Coding Alert

Published on Wed Sep 14, 2011 PDF

Question: A patient with a 1.5-cm laceration on his eyebrow presented to our practice. Our physician performed an intermediate repair. The patient also had a 3.6-cm forehead laceration that required a simple repair. Should we add these two wound lengths together and then code the intermediate repair, or does each get its own code?

Answer: In this instance, you should report code 12051 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less) for the eyebrow repair and 12013 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm) for the forehead repair.

Caution: Don't sum the wound lengths. You should only combine or add the lengths of like wounds when they're located in the same anatomic area and are of the same classification. In this case, you would report the intermediate repair separately from the simple repair.

Remember: You also need to report these two repairs separately because they are not the same type of repair -- one is simple, and the other is intermediate.

If they were both simple or both intermediate, and located in the same anatomic area, then you would add their lengths together and report one repair code.