1. What are common CPT codes for laceration repairs?
According to CPT guidelines, laceration repair codes should be reported when a physician/QHP performs a wound closure using sutures, staples, or tissue adhesives alone, in combination with each other, or with adhesive strips.
The CPT manual classifies laceration repair codes according to 3 components: the length of the laceration, the complexity of the repair (e.g., single or multilayered), and the anatomic location of the laceration:
Simple (CPT codes 12001-12021): A simple wound repair code is used when the wound is superficial, primarily involving the epidermis, dermis, or subcutaneous tissues without significant involvement of deeper structures where only one layer of closure is used (including for suture, staple, tissue adhesive, or other closure.) These include local anesthesia. Additionally, these codes can be used if chemical and/or electrocauterization is used for wounds not closed. Simple lacerations are defined by two anatomic location groupings, as below:
Intermediate (CPT codes 12031- 12057): An intermediate wound repair code would be used for wounds that require 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. It includes limited undermining (defined as a distance less than the maximum width of the defect, measured perpendicular to the closure line, along at least one entire edge of the defect). Single-layer closure of heavily contaminated wounds requiring extensive cleaning or removal of particulate matter also constitutes intermediate repair.
For intermediate (layered) wound repairs that require extensive debridement, the debridement code would be identified in addition to the repair.
Intermediate lacerations are defined by three anatomic location groupings, as below:
Complex (CPT codes 13100-13160): A complex wound repair code would be used for repairs that, in addition to the requirements for intermediate repair, require at least one of the following: exposure of bone, cartilage, tendon, or named neurovascular structure; debridement of wound edges (e.g., traumatic lacerations or avulsions); extensive undermining (defined as a distance greater than or equal to the maximum width of the defect, measured perpendicular to the closure line along at least one entire edge of the defect); involvement of free margins of helical rim, vermilion border, or nostril rim; placement of retention sutures. Necessary preparation includes creation of a limited defect for repairs or the debridement of complicated lacerations or avulsions.
Complex lacerations are defined by four anatomic location groupings, as below:
Within each of these groups, based on complexity, are codes specific to the size of the wound. For example, a simple wound repair to the scalp, neck, axillae, external genitalia, trunk, and/or extremities (including hands and feet) would use the following codes based on the size of the wound:
2. What is the difference between limited undermining in an intermediate repair versus extensive undermining in a complex repair?
Limited undermining is less than the maximum width of the wound, measured perpendicular to the closure line, along at least one entire edge of the wound.
Extensive undermining is defined as a distance greater than or equal to the maximum width of the wound, measured perpendicular to the closure line along at least one entire edge of the wound.
3. Is it possible to bill for multiple wound repairs on the same patient?
Yes. When more than one wound is repaired, all should be coded. If a patient has multiple lacerations of the same repair complexity (e.g. intermediate) on the same body part, the lengths of all wounds on that body part should be summed to determine the appropriate code. For example, suppose a patient had two lacerations on the forearm (one 1.5 cm and one 3.0 cm) requiring simple repair. In that case, the physician/QHP should code for a 4.5 cm simple repair of the forearm using the code 12002 (simple repair to extremities, 2.6 cm-7.cm wound.) Wounds from different body parts should be billed separately.
If there is more than one repair complexity performed, the more complex repair should be listed first, with modifier “51” added to the secondary (and beyond) procedure, which designates multiple procedures performed at the same encounter by the same physician/QHP. For example, if a patient had a simple 2.5 cm laceration on the scalp and a 5 cm intermediate laceration on the lower leg, the physician/QHP should code: 12032 (intermediate repair to the extremities) and 12001-51 (simple repair to the scalp.)
4. What if a superficial wound is closed with adhesive strips? Should this be billed for as a separate procedure?
No. Repair of a superficial wound with adhesive strips in isolation (i.e., no sutures or tissue adhesives) would be included as part of the evaluation and management code for the ED visit. It should not be billed as a separate procedure.
5. What documentation is required when billing for laceration repairs?
The physician/QHP should document a procedure note that includes the following when applicable:
6. What code should be used if a wound is debrided but left to heal by secondary intention?
Debridement is considered a separate procedure only when:
7. What code should be used if a wound is debrided?
Wound debridement, 97597, would be the appropriate CPT code for removing devitalized and/or necrotic tissue and nonviable tissue. No living tissue is removed in selective debridement. Routine cleansing of a wound does not represent debridement. Of note, anesthesia/local infiltration, including peripheral nerve blocks used as part of the debridement procedure, are NOT separately billable.
Updated April 2023
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