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Wiki Simple, Intermediate or Complex closure?

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jdibble

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My surgeon performed laceration repairs under anesthesia for a little girl who put her arms through a glass window. She repaired an 8cm laceration on her left forearm, which appears to be a simple repair - nothing noted about irrigation or layered closure.

She also repaired 3 other lacerations on her right arm - One is 2cm and was jet irrigated then closed. Another was 1 cm, jet irrigated, a small ellipse of devitalized skin was excised and then closed. The 3rd was V shaped with a flap of skin which was viable, measured 10cm x 4 cm x 1cm. She states "there was 1 area where the defect went into the muscle and this was closed with 4-0 Vicryl suture. The wound was jet irrigated and closed with a combination of Insure stapling device and 4-0 chromic."

My question is what codes would you consider these repairs? Would you code intermediate for the 2cm and 1 cm wound? Would you consider the other laceration complicated (if only mentioned that one area without measurement of muscle involvement) or intermediate - and how would you total the length of a V shaped flap - the total of all sides? I am not sure if documentation of jet irrigation is enough information to show a grossly contaminated wound for intermediate repair without mention of layered closure.

Any help would be greatly appreciated! :D

Thanks,
 
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