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  • What are common CPT codes for laceration repairs?

    Recommendations
    Answer

    According to CPT guidelines, laceration repair codes should be reported when a provider performs a wound closure using sutures, staples, or tissue adhesives either alone, in combination with each other, or together with adhesive strips.

    The CPT manual classifies laceration repair codes according to 3 components: 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 2 anatomic location groupings as below:

    12001-12007: simple repair to scalp, neck, axilla, external genitalia, trunk, and/or extremities (including hands and feet)

    G0168: simple repair using tissue adhesive only and when claim is billed to Medicare

    12011-12018: simple repair to face, ears, eyelids, nose, lips, and/or mucous membranes

    Intermediate (CPT codes 12031- 12057): An intermediate wound repair code would be used for wounds that, in addition to the requirements for simple repair, involve a layered closure of one or more of the deeper layers of subcutaneous tissue and superficial fascia in addition to closing the epidermal and dermal layers of the skin.  Additionally, a single-layer closure of a heavily contaminated wound that requires extensive cleaning or debridement may also be billed as an 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 3 anatomic location groupings as below:

    12031-12037: intermediate repair to scalp, axilla, trunk, and/or extremities (including hands and feet)

    12041-12047: intermediate repair to neck, hands, feet and/or external genitalia

    12051-12057: intermediate repair to face, ears, eyelids, nose, lips, and/or mucous membranes

    Complex (CPT codes 13100-13160): A complex wound repair code would be used for repairs that require more than the layered closure described for intermediate wounds.  These include scar revision, debridement of traumatic lacerations or avulsions, extensive undermining, stents, or retention sutures. Complex lacerations are defined by 4 anatomic location groupings as below:

    13100-13102: complex repair to the trunk

    13120-13122: complex repair to scalp, arms, and/or legs

    13131-13133: complex repair to forehead, cheeks, chin, mouth, neck, axilla, genitalia, hands, and/or feet

    13151-13153: complex repair to eyelids, nose, ears, and/or lips

    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:

    12001:  ≤ 2.5cm

    12002: 2.6-7.5cm

    12004: 7.6cm-12.5cm

    12005: 12.6cm-20.0cm

    12006: 20.1cm-30.0cm

    12007: >30cm

    Answer

    According to CPT guidelines, laceration repair codes should be reported when a provider performs a wound closure using sutures, staples, or tissue adhesives either alone, in combination with each other, or together with adhesive strips.

    The CPT manual classifies laceration repair codes according to 3 components: 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 2 anatomic location groupings as below:

    12001-12007: simple repair to scalp, neck, axilla, external genitalia, trunk, and/or extremities (including hands and feet)

    G0168: simple repair using tissue adhesive only and when claim is billed to Medicare

    12011-12018: simple repair to face, ears, eyelids, nose, lips, and/or mucous membranes

    Intermediate (CPT codes 12031- 12057): An intermediate wound repair code would be used for wounds that, in addition to the requirements for simple repair, involve a layered closure of one or more of the deeper layers of subcutaneous tissue and superficial fascia in addition to closing the epidermal and dermal layers of the skin.  Additionally, a single-layer closure of a heavily contaminated wound that requires extensive cleaning or debridement may also be billed as an 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 3 anatomic location groupings as below:

    12031-12037: intermediate repair to scalp, axilla, trunk, and/or extremities (including hands and feet)

    12041-12047: intermediate repair to neck, hands, feet and/or external genitalia

    12051-12057: intermediate repair to face, ears, eyelids, nose, lips, and/or mucous membranes

    Complex (CPT codes 13100-13160): A complex wound repair code would be used for repairs that require more than the layered closure described for intermediate wounds.  These include scar revision, debridement of traumatic lacerations or avulsions, extensive undermining, stents, or retention sutures. Complex lacerations are defined by 4 anatomic location groupings as below:

    13100-13102: complex repair to the trunk

    13120-13122: complex repair to scalp, arms, and/or legs

    13131-13133: complex repair to forehead, cheeks, chin, mouth, neck, axilla, genitalia, hands, and/or feet

    13151-13153: complex repair to eyelids, nose, ears, and/or lips

    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:

    12001:  ≤ 2.5cm

    12002: 2.6-7.5cm

    12004: 7.6cm-12.5cm

    12005: 12.6cm-20.0cm

    12006: 20.1cm-30.0cm

    12007: >30cm

  • Is it possible to bill for multiple wound repairs on the same patient?

    Recommendations
    Answer

    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, if a patient had 2 lacerations on the forearm (one 1.5cm and one 3.0cm) requiring simple repair, the provider should code for a 4.5cm simple repair of the forearm using the code 12002 (simple repair to extremities, 2.6cm-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 were performed at the same encounter by the same provider.  For example, if a patient had a simple, 2.5cm laceration on the scalp and a 5cm intermediate laceration on the lower leg, the provider should code: 12032 (intermediate repair to the extremities) and 12001-51 (simple repair to scalp.)

    Answer

    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, if a patient had 2 lacerations on the forearm (one 1.5cm and one 3.0cm) requiring simple repair, the provider should code for a 4.5cm simple repair of the forearm using the code 12002 (simple repair to extremities, 2.6cm-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 were performed at the same encounter by the same provider.  For example, if a patient had a simple, 2.5cm laceration on the scalp and a 5cm intermediate laceration on the lower leg, the provider should code: 12032 (intermediate repair to the extremities) and 12001-51 (simple repair to scalp.)

  • What if a superficial wound is closed with adhesive strips? Should this be billed for as a separate procedure?

    Recommendations
    Answer

    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 and should not be billed as a separate procedure.

    Answer

    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 and should not be billed as a separate procedure.

  • What documentation is required when billing for laceration repairs?

    Recommendations
    Answer

    The following elements are required for appropriate documentation of laceration repairs:

    • Size of the wound in centimeters (regardless of shape) after closure
    • Anatomical location of wound (e.g. face, trunk, hand)
    • Complexity of the wound (as defined above)

     

    Answer

    The following elements are required for appropriate documentation of laceration repairs:

    • Size of the wound in centimeters (regardless of shape) after closure
    • Anatomical location of wound (e.g. face, trunk, hand)
    • Complexity of the wound (as defined above)

     

  • What code should be used if a wound is debrided but left to heal by secondary intention?

    Recommendations
    Answer

    Wound debridement: 97597 would be the appropriate CPT code for wound selective debridement when an extensive cleaning of a wound is needed prior to placing dressings or repair by primary intention.  This code requires the presence of devitalized tissue and involves only removal of 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.

    Answer

    Wound debridement: 97597 would be the appropriate CPT code for wound selective debridement when an extensive cleaning of a wound is needed prior to placing dressings or repair by primary intention.  This code requires the presence of devitalized tissue and involves only removal of 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.

  • What code should be used if a wound is debrided?

    Recommendations
    Answer

    Wound debridement: 97597 would be the appropriate CPT code the removal of devitalized and/or necrotic tissue; removal of 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.

    Answer

    Wound debridement: 97597 would be the appropriate CPT code the removal of devitalized and/or necrotic tissue; removal of 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.

  • Can I bill for follow-up visits and suture removal after performing a Laceration Repair?

    Recommendations
    Answer

    See the ACEP FAQ set Surgical Package for coding guidance regarding subsequent visits and suture removals for laceration repairs.

    Answer

    See the ACEP FAQ set Surgical Package for coding guidance regarding subsequent visits and suture removals for laceration repairs.

Updated March 2021

Disclaimer

The American College of Emergency Physicians (ACEP) has developed the Reimbursement & Coding FAQs and Pearls for informational purposes only.   The FAQs and Pearls have been developed by sources knowledgeable in their fields, reviewed by a committee, and are intended to describe current coding practice. However, ACEP cannot guarantee that the information contained in the FAQs and Pearls is in every respect accurate, complete, or up to date.

The FAQs and Pearls are provided "as is" without warranty of any kind, either express or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. Payment policies can vary from payer to payer. ACEP, its committee members, authors or editors assume no responsibility for, and expressly disclaim liability for, damages of any kind arising out of or relating to any use, non-use, interpretation of, or reliance on information contained or not contained in the FAQs and Pearls. In no event shall ACEP be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Specific coding or payment related issues should be directed to the payer.

For information about this FAQ/Pearl, or to provide feedback, please contact David A. McKenzie, ACEP Reimbursement Director at (469) 499-0133 or dmckenzie@acep.org.

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