Medical Claims

When Coding Multiple Wound Repairs in CPT Gets Tough for Medical Billers?

When coding multiple wound repairs in CPT gets tough for medical billers

Correct coding for any practice is necessary for everything. No matter what you are coding for, using the standard procedure of adding CPT codes designated for the specific health condition is necessary for on-time reimbursement.

When you are coding for multiple services you rendered after an accident, how and when coding multiple wound repairs in CPT will be written? For dermatologists, accurate coding for wound repairs can be tricky due to several complications. For billing, it is essential for the medical coders to specifically understand the anatomy of the layers of the skin and use the specified coding to examine the clinical documentation.

To determine the codes and guidelines used for the services used to treat damaged and ruptured skin under the tag lesion excision, shaving, tag removal, and wound repairs, reviewing the use of the code is imperative. For appropriate coding for reporting multiple wound repairs need a thorough analysis of clinical documentation in order to determine;

  • Location of the wounds
  • Layers involved in the treatment,
  • Length of the wound in centimeters

These variables are specifically specified in CPT repair standard codes. The listed repairs include staples, sutures, and tissue adhesive both single or combined adhesive strips. Wounds that are repaired using adhesive materials only should be listed adhering to the specific coding and management (E/M) codes. Wounds repaired using tissue adhesives such as Dermabond must be reported with HCPCS Level II code G0168 wound closure code to Medicare as adhesives used for tissue repairing only. Other than Medicare, other commercial payers allow billers to use simple repair codes in order to report wound repairs. These codes have a range starting from 12001 to 12018.

In the next part of the article, we will discuss and examine these three important elements used to determine the repair codes to report correct wounds treatments.

Determining when coding multiple wound repairs in CPT will work efficiently

1. Identifying the subcategory for the location of the wound

Identifying the subcategory for the location of the wound

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It’s important to determine the location of the wound, which means identifying the site of the body where the wound is repaired is important to get the correct use of code. With the level of repairs, the classification of wounds varies according to the anatomic location. These classifications, however, differ with the level of wound repair.

  • Simple repairs include – the trunk, external genitalia, neck, scalp, and extremities such as feet and hands – (12001 – 12007). For eyelids, lips, nose, face, or/and mucous membranes (121011 – 12015)
  • Intermediate repairs – Trunk, axillae, scalp, extremities excluding feet and hands (12031 – 12037). For feet, hands, neck, and external genitalia (12051 – 12057). For eyelids, ears, lips, face, mucous membrane (12051 – 12057)
  • Complex repairs – Trunk (13100-13102), for arms, scalp, or legs (13120 – 13122). For forehead, mouth, chin, neck hands, genitalia, cheeks, and/or feet (13131 – 13133). For ears, nose lips, and eyelids (13151 – 13153)

2. Determining complexity in repair

To determine the exact codes for determining the complexity, medical billers and coders need to see these three categories of repair codes;

  • Simple repairs (12001 – 12021) are wounds that are full or partial superficial with moderate or full thickness skin damage. This damage can possibly be to the subcutaneous tissue. Other disclosures are not involved in the repairs as these codes only contain simple repairs with single repair layer closures. These simple repairs involve deeper layers such as muscle and skin untouched and unaffected. Any kind of anesthesia and electro cauterization or chemical use on wounds are also included to be reported in these simple repair codes.
  • Intermediate repairs – (12031 – 12057) involve the coding for more than one repair of the layers of the skin. In addition, it also involves the epidermal ad dermal repairs of the skin. Wounds that need intermediate repairs are some of the deeper cuts and need the treatment for intermediate repairs for more than one layer of the skin and sometimes the repair of the muscle tissue.
  • Complex repairs – (13100 – 13160) these codes involve deeper and extensive wound treatment such as stents, extensive undermining, layer closure like debridement, retention sutures, and scar revisions. The documentation of these codes must involve the deeper muscle closure treatment that necessitates the creation of repair using essential medical supplies.

3. Figuring out wound length

The final and foremost code selection after defining the location and complexity of the would-be defined by the size of the wound. How deep and wide it is. The measurement of the wound should be documented in centimeters. No matter how curved, stellate or angular it is. If the wound documents have the measurements in inches or any other unit, it is suggested to convert the unit in centimeters when reporting them to the payer.

The correct use of CPT codes for wound repairs will reimburse the practice timely. This is why it is important to figure out what kind of codes will be used according to the intensity of the wound. The payer may reject the claim if the CPT codes for wound repairs are not specified correctly. Eventually, it will affect the RCM of the practice.