Wiki Complex Repair with Soft Tissue Excision

[CatchTheWind]

We excised a lipoma (ie: soft tissue excision 24075), and wanted to bill a complex repair (13120) with it, but the repair is bundling.

What's strange is that the CPT book states that the excision includes simple and intermediate repair, and explicitly states that it "may require a complex repair, which should be reported separately." Yet the CCI edits bundle 24075 and 13120, and for a reason I've never seen before: "Standards of medical / surgical practice." What does that mean? Why would the repair not be within standards of practice?

 

[thomas7331]

CPT and NCCI guidelines are not the same and sometimes conflict, as is the case here. Under NCCI rules, with the exception of benign and malignant skin excisions, the "closure/repair of a surgical incision is included in the global surgical package. Wound repair CPT codes 12001-13153 should not be reported separately to describe closure of surgical incisions for procedures with global surgery indicators of 000, 010, 090 or MMM". So the RVU value of all other surgical codes is calculated to include the closure, and any payer that follows CMS-established reimbursement would bundle the complex closure because the payment is included in the primary procedure. Although according to CPT coding guidelines you can report the code, you wouldn't be able to append the modifier to override the bundling (unless of course the documentation supported this as a separate/unrelated procedure).