Q/A: Coding for Lesion Removal and Repair

June 5th, 2018 - Chris Woolstenhulme QCC, CMCS, CPC, CMRS
Categories:   CPT® Coding   Billing   Home Health|Hospice   Primary Care|Family Care   Skilled Nursing   Podiatry  
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Q: The CPT book does not indicate repairs, measuring .5 cm and less, during lesion removal. Does this mean that an intermediate or complex repair of .5 cm is not billable? If it can be billed, and the lesion is .5 or less, but the repair is bigger, do we decide based on the size of the lesion or the size of final defect?

A: Repair and closures are determined by the three classifications Simple, Intermediate and Complex. These classifications are determined by the effort involved in the repair.

For example a simple repair: is reported for a superficial wound that involves primarily the epidermis, dermis, or subcutaneous tissues, requiring a one layer closure.

Intermediate repair is reported for one or deeper layers (non-muscle) or a single layer closure of heavily contaminated, that required extensive cleaning, also the removal of particulate matter constitutes intermediate repair.

Complex repair requires more than layer closures, with extensive undermining, stents or retention sutures, scar revision, debridement for traumatic lacerations or avulsions. (NOTE, decontamination and debridement is considered a separate procedure).

With that being said once the classification has been determined you then add the sum of lengths or repairs for each group of anatomic site and code according to the site and length of the repair.

12001 - Simple repair is for 2.5 cm or less
12031 - Intermediate repair of 2.5 cm or less

Anything less than a simple repair such as using adhesive strips would be reported with an E/M code.

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