PDA

View Full Version : simple, intermediate, or complex?


Emingoy114
08-12-2011, 07:51 PM
What determines if a repair is simple, intermediate, or complex?

Mojo
08-12-2011, 09:38 PM
CPT defines each of the closures in the integumentary system section (before code 12001). Note the use of modifier 51 in the instructions.

Some tips for wound repairs:
Simple repairs involve single layer closure with sutures, staples or skin adhesives (Dermabond). Report G0168 (Wound closure utilizing tissue adhesive[s] only) for Medicare payers. You may see the use of chemical (silver nitrate) or electrocautery.

Steri-strips alone are not assigned a wound repair code.

Intermediate repairs include those requiring multi-layered closure or single layer repair that are heavily contaminated.

If the physician mentions repair to the depth of muscle or deeper, it’s complex. Complex repairs are often reconstructive procedures and include creation of a defect to be repaired (for instance, excision of the scar and subsequent closure).

Good luck on the exam. :)

AL
08-12-2011, 09:39 PM
Per CPT:
Simple repair is used when the wound is superficial; eg, involving primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures, and requires simple one layer closure. This includes local anesthesia and chemical or electrocauterization of wounds not closed.

Intermediate repair includes the repair of wounds that, in addition to the above, require layered closure of one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition to the skin (epidermal and dermal) closure. Single-layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair.

Complex repair includes the repair of wounds requiring more than layered closure, viz., scar revision, debridement (eg, traumatic lacerations or avulsions), extensive undermining, stents or retention sutures. Necessary preparation includes creation of a limited defect for repairs or the debridement of complicated lacerations or avulsions. Complex repair does not include excision of benign (11400-11446) or malignant (11600-11646) lesions, excisional preparation of a wound bed (15002-15005) or debridement of an open fracture or open dislocation.

DeeCPC
08-13-2011, 07:30 AM
Documentation of 'layered closure' is not enough to code an intermediate repair.

Documentation needs to state, " layered closure of one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition to the skin (epidermal and dermal) closure. Single-layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair."

And complex must state the above (deeper layers of subcutaneous...)PLUS more than layered closure, viz., scar revision, debridement (eg, traumatic lacerations or avulsions), extensive undermining, stents or retention sutures.
CPT does not describe 'extensive' undermining.

Dee, CPC,CPCD,CPMA

Mojo
08-13-2011, 05:47 PM
Documentation of 'layered closure' is not enough to code an intermediate repair.

Documentation needs to state, " layered closure of one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition to the skin (epidermal and dermal) closure.

Dee, CPC,CPCD,CPMA

Absolutely, Dee. I posted the tip as a suggestion that when a coder sees "multi-layer" it may be a heads-up to an intermediate repair if the documentation supports it. A sutured dermal layer followed by Dermabond or sutures through the epidermis would still be a simple repair.