Laceration Repair Coding Guidelines

   The CPT Manual categorizes laceration repair codes in to three types of repairs:
  • Simple
  • Intermediate
  • Complex
       The CPT guidelines clearly state that the repaired wound(s) should be measured and documented using centimeters regardless of whether the repair is curved, angular, or stellate (i.e., star-shaped).

Simple Repairs:

      Simple repair is used when the wound is superficial (involving primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures) and requires simple one layer closure.

      The simple repair codes include all local anesthesia and chemical or electrocauterization of wounds not closed. The codes are further classified by the anatomical location and length of the repair.
  • 12001: Simple/Superficial -- Scalp, Neck, Axillae, External Genitalia, Trunk, Extremities with 2.5 cm or less
  • 12002: 2.6 cm to 7.5 cm
  • 12004: 7.6 cm to 12.5 cm
  • 12005: 12.6 cm to 20.0 cm
  • 12006: 20.1 cm to 30.0 cm
  • 12007: over 30.0 cm
  • 12011: Simple/Superficial -- Face, Ears, Eyelids, Nose, Lips, Mucous Membranes with 2.5 cm or less
  • 12013: 2.6 cm to 5.0 cm
  • 12014: 5.1 cm to 7.5 cm
  • 12015: 7.6 cm to 12.5 cm
  • 12016: 12.6 cm to 20.0 cm
  • 12017: 20.1 cm to 30.0 cm
  • 12018: over 30.0 cm
  • 12020: Treatment of superficial wound dehiscence: simple closure
  • 12021: Treatment of superficial wound dehiscence: with packing
 Intermediate Repairs:

       Intermediate repair requires one 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.
       A single-layer closure of heavily contaminated wounds requiring extensive cleaning or removal of particulate matter also falls under intermediate repair codes.
  • 12031: Intermediate/Layered Closure -- Scalp, Axillae, Trunk, Extremities with 2.5 cm or less
  • 12032: 2.6 cm to 7.5 cm
  • 12034: 7.6 cm to 12.5 cm
  • 12035: 12.6 cm to 20.0 cm
  • 12036: 20.1 cm to 30.0 cm
  • 12037: over 30.0 cm
  • 12041: Intermediate/Layered Closure -- Neck, Hands, Feet, External Genitalia with 2.5 cm or less
  • 12042: 2.6 cm to 7.5 cm
  • 12044: 7.6 cm to 12.5 cm
  • 12045: 12.6 cm to 20.0 cm
  • 12046: 20.1 cm to 30.0 cm
  • 12047: over 30.0 cm
  • 12051: Intermediate/Layered Closure -- Face, Ears, Eyelids, Lips, Mucous Membranes with 2.5 cm or less
  • 12052: 2.6 cm to 5 cm
  • 12053: 5.1 cm to 7.5 cm
  • 12054: 7.6 cm to 12.5 cm
  • 12055: 12.6 cm to 20.0 cm
  • 12056: 20.1 cm to 30.0 cm
  • 12057: over 30.0 cm
Complex Repairs:

        Complex Repairs requires more than layered closure, scar revision, debridement (eg, traumatic lacerations or avulsions), extensive undermining, stents, or retention sutures. Necessary preparation includes creation of a limited defect for repairs or the debridement of complicated lacerations or avulsions.
  • 13100: Complex Repair – Trunk with 1.1 cm to 2.5 cm
  • 13101: 2.6 cm to 7.5 cm
  • 13102: each additional 5 cm or less (List separately in addition to code for primary procedure)
  • 13120: Complex Repair – Scalp, arms, legs with 1.1 cm to 2.5 cm
  • 13121: 2.6 cm to 7.5 cm
  • 13122: each additional 5 cm or less (List separately in addition to code for primary procedure)
  • 13131: Complex Repair – Forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, feet with 1.1 cm to 2.5 cm
  • 13132: 2.6 cm to 7.5 cm
  • 13133: each additional 5 cm or less (List separately in addition to code for primary procedure)
  • 13150: Complex Repair – eyelids, nose, ears, lips with 1.0 cm or less
  • 13151: 1.1 cm to 2.5 cm
  • 13152: 2.6 cm to 7.5 cm
  • 13153: each additional 5 cm or less (List separately in addition to code for primary procedure)
  • 13160: Secondary closure of surgical wound or dehiscence, extensive or complicated
Coding Multiple Laceration Repairs:

      When a provider repairs multiple lacerations, As per CPT guidelines coders to add together the lengths of repairs that fall under the same classification and the same anatomic sites (meaning those that are grouped together under the same general heading in the code descriptors). Do not to add lengths or repairs from different groupings of anatomic sites or different classifications.

       When a provider repairs more than one classification of wounds, CPT guidelines state that coders should list the more complicated procedure as primary, the less complicated procedure as secondary, and append modifier -51 (Multiple procedures) to the secondary code(s).
Example:

     A Patient presents with 1.5cm hand laceration and 2.5cm forehead laceration and Provider performed simple repair on hand and intermediate repair on forehead, Report correct CPT codes?
Ans: 12051, 12001-51

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