Wiki Coding Complex Repair- Using Add On Code

[marysaxon]

I'm coding complex repair of the arm and the amount of area that has been repaired is 26 cm so wondering if I would code that as: 13121, 13122 x 5 units or would I use the add-on code 13122 (ea additional 5 cm or less) 5 different times? The insurance company is United HealthCare.

Thanks!

 

[FTessaBartels]

Area vs Length

Makes no difference which payer you have, the guidelines for figuring the coding on repairs are the same, and explained in your CPT book.

You state that the "amount of area that has been repaired is 26 cm" ... (emphasis added by FTB)

Area is expressed in sq cm (length x width)

Repairs are coded based on the LENGTH only.

If the LENGTH of the repair is truly 26 cm (nearly a foot long) then this is how you figure it.

26 cm (TOTAL LENGTH)
- 7.5 cm (MINUS CPT 13121 maximum length)
18.5 cm (LENGTH FOR CPT 13122)

You DIVIDE the balance of 18.5 by 5 (because you code 13122 once for each unit of 5 cm or part thereof). This gives you 3.7, which you round up to 4.

So you would code: 13121, +13122 x 4

MAKE SURE you have the correct measurement before you start figuring the coding.

Hope that helps.

F Tessa Bartels, CPC, CEMC