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Thread: Laceration repair rules change?

  1. #1

    Default Laceration repair rules change?

    AAPC: Back to School
    Recently, our claims-editing software (Claims Manager) has begun to reject the billing of 12013 and 12002 on the same patient. I ran the codes through Encoder's new CCI Quick Check feature, and it also said they should not be used together.

    Has there been a change in the rules for reporting multiple laceration repairs of different sites? I know you add together multiple lacerations in the same category, but a facial laceration and a non-facial laceration repaired in the same visit should be billable separately, shouldn't they?

    Thanks for any help.

    Stacy Forsythe, CPC
    Lexington, KY

  2. #2
    Join Date
    Apr 2007


    As far as I know, they have not changed. Did you add a modifier?

  3. #3


    Not originally. Would a -51 make it clear that these are distinct procedures performed on different wounds?

  4. #4
    Join Date
    Apr 2007
    Columbia, MO


    This is what I was able to pull up on the guide to wound clousure:
    Lips and back are not grouped together. CPT code 12001 is the stand-alone code for scalp, neck, axillae, external genitalia, trunk, and/or extremities (including hands and feet). CPT code 12011 is the stand-alone code for the face, ears, eyelids, nose, lips, and/or mucous membranes. Therefore, you are not allowed to add up the sum of these simple repairs. You are instructed to code them separately. 12002 and 12011 (with modifier 51 added to this second code) are the correct codes for this case study.

    However I do not feel there would be a CCI edit wanting a 51 modifier. I think the edit is misplaced. Or perhaps it is that the scalp and face are so close together they do want a 59 modifier. Thats is all I can guess.

    Debra A. Mitchell, MSPH, CPC-H

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