Wound repairs require determining three separate components before selecting the appropriate CPT code:
- Layer – What is the depth/complexity of the wound repair?
- Location – Where on the body is the wound?
- Length – How long in centimeters is the wound repair?
Simple repairs are for superficial wounds that are uncomplicated and primarily involve the epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures. These are often documented as “single-layer closure”. If the documentation states extensive cleansing or removal of particulate matter from the wound, CPT does allow for the repair to be coded as an intermediate repair. Report simple repairs using CPT codes 12001-12018.
Intermediate repairs are more extensive and involve one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition to the skin (epidermal and dermal) closure. These are often documented as a “layered closure”. Report intermediate repairs using CPT codes 12031-12057.
Complex repairs involve more than layered closure, such as extensive undermining, stents, scar revision, debridement or retention sutures. If the documentation states repair to the depth of muscle or deeper, it’s complex. Report complex repairs using CPT codes 13100-13153.
Within each level of repair, wounds are classified according to anatomic location. Note that these categories are not identical for each level of repair.
- Scalp, neck, axillae, external genitalia, trunk, and/or extremities (including hands and feet)
- Face, ears, eyelids, nose, lips, and/or mucous membranes (See 12011-12018.)
- Scalp, axillae, trunk, and/or extremities (excluding hands and feet)
- Neck, hands, feet, and/or external genitalia
- Face, ears, eyelids, nose, lips, and/or mucous membranes
- Scalp, arms, and/or legs
- Forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet
- Eyelids, nose, ears, and/or lips
Final code selection requires:
- The measurement in centimeters (cm). If the documentation states millimeters, the measurement must be converted to centimeters before selecting the appropriate code.
- Adding the lengths of repair together that are performed in the same anatomic group under the same classification (simple, intermediate or complex).
- Do not add lengths of repairs from different groupings of anatomic sites (e.g. face and neck). Also, do not add together lengths of different classifications (e.g. intermediate and complex repairs).
- Wounds repaired with only adhesive strips are inclusive of the E/M code.
- Wounds repaired only with Dermabond or other tissue adhesive are reported to Medicare with HCPCS code G0168. Commercial carriers allow Simple Repair codes (12001-12021) to be reported.