Extensive Cleaning May Denote A Higher-level Code

By Author: erinarticle
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During a particular scenario, a patient presents with 1.5-cm laceration of the eyebrow, and the dermatologist performs an intermediate repair. The patient also has a 3.6-cm forehead laceration that calls for a simple repair. How should I go about these procedures?


In this situation, you should report the intermediate wound separately from the simple closure. As such, you should claim 12051 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 centimeter or less) for the eyebrow repair and 12013 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 centimeter to 5.0 centimeter) for the forehead repair.


Bear in mind: Report these two pairs separately since they are not the same type of repair - 12013 is simple while the other - 12051 – is intermediate. If the dermatologist carries out two simple or for that matter intermediate repairs and he completed the procedures at the same anatomic area, you'd add their lengths together and report one repair code.


Additional ...
... benefit: According to CPT guidelines, if the dermatologist uses single-layer closure to treat a heavily contaminated wound that calls for ‘extended cleaning and/or removal of substantial amounts of devitalized/contaminated tissue, you may be right in reporting intermediate repairs (12031-12057). This warning allows you to report intermediate codes for well-documented single-layer repairs that are heavily contaminated; however your documentation must include descriptive details about the procedure such as ‘prior to closure', the wound required the dermatologist to carry out extensive cleaning of the site.


For more on this and for other specialty-specific articles to assist your dermatology coding, sign up for a good medical coding resource like Coding Institute.