Forum - Questions & Answers

Apr 27th, 2018 - sharris

Leison removal and repair

Many times provider is indicating intermediate repair or complex repair for under 1cm. In the CPT book under complex repair it indicates "for 1.0cm or less, see simple or intermediate repair".

So in the scenario of lesion removal the provider indicates 1.0 cm of less for intermediate repair after lesion removal Does that mean since the next one down is simple we would not bill a repair?

There is nothing in the CPT book that indicates repairs of .5cm and less during lesion removal. I would think that intermediate or complex of .5cm is not billable?

If this is true, If the lesion is .5 or less but the repair is bigger do we decide based upon the size of the lesion or the size of final defect?

Thank You very much

Jun 5th, 2018 - ChrisW   256  1 

re: Leison removal and repair

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 or 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 is used for an 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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