Dermatology Coding: Extensive Cleaning May Denote A Higher-level Code

By Author: erinarticle
Total Articles: 105
Comment this article

In a particular scenario, a patient presents with a 1.5-cm laceration of the eyebrow, and the dermatologist carries out an intermediate repair. The patient also has a 3.6-centimeter forehead laceration that calls for a simple repair. How should these procedures be reported?


Answer: In this situation, you should report the intermediate wound separately from the simple closure. As such, 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: You should report these two repairs separately since they are not the same type of repair -- one (12013) is simple, while the other (12051) is intermediate. If the dermatologist carried out two simple (or intermediate) repairs and he finished the procedures at the same anatomic area, you would add their lengths together and report one repair code.


Advantage: ...
... If the dermatologist uses single-layer closure to repair a heavily contaminated wound(s) that needs ‘extended cleaning and/or removal of substantial amounts of devitalized/contaminated tissue', you may be justified in reporting intermediate repairs (12031-12057), as per CPT guidelines. 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 like “prior to closure, the wound required the dermatologist to perform 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.