Wiki Simple VS Intermediate Repair

[AHESLER]

If a patient comes in for a simple laceration and a simple repair was done, does the repair become an intermediate repair because the laceration was caused by a dog bite? Does the fact that the wound is heavily contaminated from the dogs mouth mean that this goes from a simple repair to an intermediate? Also when deciding on which repair type to choose is the level of risk a factor in making the decision?
Thanks!

 

[thomas7331]

Per CPT, intermediate repair can be reported for single-layer closures "of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter". The fact that is was caused by a dog bite is not really relevant to the code choice - the choice of simple vs. intermediate would depend on whether the documentation of the extra work performed supports this description of a cleaning of a heavily contaminating wound.

Since the repairs are considered minor procedures, they would fall under low risk under 'minor surgery with no identified risk factors' management options in the risk table (unless other factors are involved), however, the E&M associated with the decision to perform this procedure is inclusive to the procedure itself and not separately reportable, so the level of risk of the procedure would not be relevant to an E&M performed at the same encounter. If a separately identifiable E&M is performed that supports a modifier 25, then you would just select the risk associated with that separate service, not with that of the laceration repair.

 

[AHESLER]

Thank you that information is very helpful. I have a doctor that believes the opposite of what you have said and I have had a hard time finding documentation that supports this to show him.