Wound repairs may be classified as simple, intermediate, or complex. Applicable codes should be used based on the definitions below.
Wound repairs may be classified as simple, intermediate, or complex and should be coded using the following guidelines:
A simple wound repair code should be used when the wound is superficial (e.g., involving primarily epidermis, dermis, or subcutaneous tissues without significant involvement of deeper structures) and requires a simple one-layer closure/suture. CPT codes for simple wound repair include local anesthesia and chemical or electrocauterization of wounds not closed.
The repair of a superficial wound that does not require sutures but may be closed with adhesive strips is included in the fee for the evaluation and management (E/M) visit and should not be billed separately.
An intermediate wound repair code includes the repair of a wound that, in addition to the above, requires a 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. The single-layer closure of a heavily contaminated wound that requires extensive cleaning or removal of particulate matter also may also be considered an intermediate repair.
A complex wound repair code includes the repair of a wound requiring more than a layered closure (e.g., scar revision or debridement), extensive undermining, stents, or retention sutures. It may also include debridement and repair of complicated lacerations or avulsions.
For wound repair to be eligible for payment at the complex level, an operative report must be submitted with the claim. If the report is not included, the claim will be denied.
Services related to wound repair should be coded using the following guidelines:
Debridement may be billed separately when (1) the wound is grossly contaminated and requires prolonged cleansing, (2) appreciable amounts of devitalized or contaminated tissue are removed, or (3) debridement is carried out separately without immediate primary closure.
Repair of nerves, blood vessels, and tendons
Simple ligation of vessels in an open wound is considered part of the wound closure and should not be billed separately. Simple "exploration" of nerves, blood vessels, or tendons exposed in an open wound is also considered part of the wound repair and should not be billed separately. Repair of more extensive nerve, blood vessel, or tendon damage may be reported separately if the wound is classified as a complex wound.
If a wound requires enlargement, extension of dissection (to determine penetration), debridement, removal of foreign bodies, ligation, or coagulation of minor vessels of the subcutaneous tissues, muscle fascia and/or muscle (not requiring thoracotomy or laparotomy), the exploration may be billed separately using CPT codes 20100 through 20103.
MM: September 2011
|Rev#:||Date:||Nature of Change:|
|1.0||03/23/2005||Added note about application of payment when both a primary procedure and an intermediate or complex repair are approved.|
|2.0||03/15/2007||This document consolidates versions for multiple provider types into a single document.|
|2.1||05/17/2007||Removed paragraph indicating that an operative report must be submitted with the claim for an intermediate wound repair code. This is no longer required. Also fixed two minor typos.|
|2.2||02/10/2009||Under COMPLEX wound entry, added: For wound repair to be eligible for payment at the complex level, an operative report must be submitted with the claim. If the report is not included, the claim will be denied.|
|2.3||12/02/2010||Removed the "Notes" section.|
|2.4||11/29/2011||Added: "Wound repairs may be classified as simple, intermediate, or complex and should be coded using the following guidelines:" and changed "Wound classification" to "Wound repairs"|
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