Lesion removal

"They were closed in multiple layers, using 4-0 vicryl for the dermis and 5-0 nylon for the skin."

Nancy - I am not sure if this went through as I had an erro come up. There is a provider that indicates this statement in every lesion removal.

He wants to bill intermediate repair for each lesion removal he does. I do not feel this is intermediate repair. Yes he had layers but he only states dermis and skin.

I find it hard to believe that every pt. has intermediate repair performed. If you ask him he states yes this is intermediate repair.

Can you give me your opninion on this?

Thanks

re: Lesion removal

Intermediate repair (12031 – 12057) includes, in addition to the requirements of a
simple repair, “…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.”
An intermediate repair may be coded if the physician performed a layered closure or a single-layered closure that required extensive debridement. If the
documentation shows that the physician performed a deep layered closure on the
patient’s wound using staples for the method of repair, then the physician would be able to use an intermediate repair code from the surgery section. Or, if the documentation reveals that the physician performed a single-layered closure only but he had to perform extensive debridement in addition to the single-layered closure, therefore going above and beyond normal debridement, the physician may bill for the intermediate repair code.
Also, note that the physician does not need to specifically use the word “intermediate” in the documentation to bill for an intermediate repair. A layered closure constitutes an intermediate repair, therefore he may simply document that a layered closure was
performed.
Use of the same statement in every lesion excision will raise a red flag. Intermediate repair pertains to a deep layered closure. The bottom line is, it is the physician's decision to make but the coders responsibility to point out the pattern and the fact that billing an intermediate repair on every lesion excision is suspect to a potential audit.

re: Lesion removal

Simple, or single-layer, repairs involve “primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures,” according to CPT®.