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Thread: repair levels help

  1. #1

    Default repair levels help

    AAPC: Back to School
    I'm having trouble figuring out what determines a wound to have a simple,intermediate, or complex repair. I've read the guidelines several times but they seem somewhat vague.
    Is there any sure way, like, key terms to watch out for that would help me determine the correct repair level?

  2. #2
    Join Date
    Apr 2007
    San Antonio,TX


    PT guidelines clearly state that the repaired wound(s) should be measured and documented using centimeters regardless of whether the repair is curved, angular, or stellate (i.e., star-shaped).
    imple repairs

    Report the simple repair codes (12001–12018) for superficial wounds that require a simple, one layer closure. Providers typically perform a simple repair when the wound primarily involves the epidermis, dermis, or subcutaneous tissues, but no deeper structures.

    The simple repair codes include all local anesthesia and chemical or electrocauterization of wounds not closed. The codes are further classified by the anatomical location and length of the repair.

    For example, refer to codes 12001–12007 to report simple wound repairs to the following anatomical locations:

    External genitalia
    Extremities including the hands and feet

    Code selection depends on the length of the repair. For example, assign code 12001 for a repair involving any of the aforementioned anatomical locations that are 2.5 cm or less; but report code 12002 for repairs that are 2.6 cm to 7.5 cm.

    The CPT Manual also provides two additional codes:

    12020: Treatment of superficial wound dehiscence; simple closure
    12021: Treatment of superficial wound dehiscence; with packing

    These codes are used when a wound closure ruptures in some way, and the provider must either repair the dehiscence using a simple repair or with wound packing.
    The intermediate repair codes include the repair of wounds that require a layered closure of one or more of the deeper layers of subcutaneous tissue and superficial fascia in addition to a simple repair and skin closure.

    The CPT Manual also states that a single-layer closure of heavily contaminated wounds requiring extensive cleaning or the removal of particulate matter also falls under intermediate repair codes.

    Like the simple repair codes, the intermediate repair codes (12031–12057) are further classified by the anatomical location and the length of the repair.

    Coders should familiarize themselves with the descriptions for each laceration repair code. This is because there are only subtle differences in terminology between the descriptions for simple vs. intermediate repairs. Consider the following two examples:

    Code 12001: Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less
    Code 12031: Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less
    Complex repairs

    A complex repair requires more than a layered closure, viz., scar revision, debridement, extensive undermining, or stents or retention sutures. It also involves necessary preparation, including the creation of a defect for repairs or the debridement of complicated lacerations or avulsions.

    Note that complex repairs do not include excisions of benign or malignant lesions.

    Complex repair codes (13100–13153) differ from the intermediate or simple repair codes, as there are several add-on codes that apply to these types of repairs. Consider the following two examples:

    Code 13121: Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm
    Add-on code 13122: Each additional 5 cm or less (Report in conjunction with code 13121)

    Note the parenthetical notations for some complex repair codes. For example, code 13100 (Repair, complex, trunk; 1.1 cm to 2.5 cm) includes a parenthetical notation below the code indicating that when the repair is 1.0 cm or less, coders should ‘See simple or intermediate repairs.’

    When a provider repairs multiple lacerations, CPT guidelines direct coders to add together the lengths of repairs that fall under the same classification and the same anatomic sites (meaning those that are grouped together under the same general heading in the code descriptors). Do not to add lengths or repairs from different groupings of anatomic sites or different classifications.

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