Podiatry Coding & Billing Alert

If podiatrist closes wound using adhesive strips as main repair material, report E/M code instead of repair code.

Distinguishing the differences between different types of wound repairs might seem daunting at first because the CPT^® guidelines offer abundant guidance on how you should report these codes. For example, to appropriately report wound repair, you must first identify whether the podiatrist performed a simple, intermediate, or complex repair.

Read on to learn how to always submit clean wound repair claims in your podiatry office.

Investigate This Simple Wound Repair Scenario

If your podiatrist closes a foot wound that primarily involves the dermis and epidermis, then you have a simple repair. You might see mention of subcutaneous tissues in the medical documentation, but not deep layers.

Simple repairs defined: Wound repair is considered simple when the wound is superficial and requires simple, one-layer closure.

Superficial wounds are defined as those that involve “primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures,” according to the guidelines. Simple repair also includes “local anesthesia and chemical or electrocauterization of wounds not closed.”

Example: The podiatrist uses staples to perform a simple repair of a minor laceration on the right foot of a new patient. This superficial wound measures 2.5 cm.

You should report 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) for this service.

Meet Criteria for Intermediate Wound Closure

If the podiatrist goes any deeper than the skin’s superficial layers, the documentation should indicate an “intermediate repair,” which means the podiatrist performed one of the two following services:

• Layered closure of one or more deeper layers of subcutaneous tissue and superficial (non-muscle) fascia in addition to the skin (epidermal and dermal) closure; or
• Single-layer closure of heavily contaminated wounds requiring extensive cleaning or removal of particulate matter.

When you report intermediate wound repair, you can look to the following codes:

• 12041 (Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less
• 12042 (… 2.6 cm to 7.5 cm)
• 12044 (… 7.6 cm to 12.5 cm)
• 12045 (… 12.6 cm to 20.0 cm)
• 12046 (… 20.1 cm to 30.0 cm)
• 12047 (… over 30.0 cm).

Example: The podiatrist uses sutures to perform intermediate wound repair for a patient. He performs a layered closure of two deeper layers of subcutaneous tissue and superficial fascia, as well as an epidermal closure, for a wound on the patient’s left foot. The wound measures 2.6 cm.

You should report 12042 for this service.

Observe 3 Complex Wound Repair Code Choices

Complex repairs include wound repair that require more than layered closure. Complex repair may require scar revision; debridement (in traumatic lacerations or avulsions); extensive undermining; stents; or retention sutures, per the guidelines.

“Necessary preparation includes creation of a limited defect for repairs or the debridement of complicated lacerations or avulsions,” the guidelines add. The physician would create a limited defect when he removes deep tissue, but cannot replace it, which would leave a crater-like deformity that he may need to pack open or possibly graft, Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan, further explains.

Caution: Complex repair does not include the excision of benign lesions (11400-11446); the excision of malignant lesions (11600-11646); excisional preparation of a wound bed (15002-15005); or the debridement of open fractures or dislocations, according to the guidelines.

You would look to the following complex wound repair codes for podiatry patients:

• 13131 (Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm)
• 13132 (…2.6 cm to 7.5 cm).
• +13133 (… each additional 5 cm or less (List separately in addition to code for primary procedure)). You should report +13133 in conjunction with 13132, according to CPT^®.

Podiatrist Uses Adhesive Strips As Main Repair Material? Do This

Don’t miss: When the podiatrist closes the wound using adhesive strips as the main repair material, you should report this service with the appropriate evaluation and management (E/M) code, not a repair code, according to CPT^®.

Example: The podiatrist uses adhesive strips to close a minor laceration on the right foot of a new patient. This superficial wound measured 2.5 cm. The podiatrist spends about 10 minutes with the patient. He uses straightforward medical decision making, and he performs a problem focused history and a problem focused examination. You would report 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making) for this service.

Don’t miss: If your podiatrist performs a single-layer laceration repair on a Medicare patient and uses tissue adhesives only, not sutures, or staples, then you should report G0168 (Wound closure utilizing tissue adhesive(s) only). However, if the podiatrist uses sutures instead of tissue adhesive for a Medicare patient, you would then rely on the standard suture/repair codes.