Practices interested in ethically boosting their bottom line and getting $80 or more for the same closure repair need to walk the line that separates simple from intermediate.
What Makes a Repair “Simple”?
A wound closure is a simple repair if the procedure:
- is simple;
- is a single-layer closure involving the epidermis, dermis, or subcutaneous tissues; and
- does not involve deeper structures.
Code these closures with 12001-12021, confirms Dilsia Santiago, CCS, CCS-P, a coder in Reading, Pa. And remember that simple repair includes “local anesthesia, and chemical or electrocauterization of wounds not closed,” she continues.
Example: The ED physician examines a 22-year-old patient’s scalp wound …
Utilizing prolene sutures the physician closes a 2.3 cm single-layer wound. On the claim, you’d report 12001 (Simple repair of wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less) for this encounter.
Simple, Intermediate: Does It Really Matter?
If you’re interested in more money for the same service, knowing the difference between simple and intermediate repairs is vital.
Example: Let’s say the ED physician closes a 2.9 cm laceration on a patient’s forehead. You report 12013 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm) for the service; encounter notes justify an intermediate repair because the physician needed to perform layered closure of the wound, however, so you should have opted for 12052 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm).
Payout: The wrong code here will cost you about $90. The 12013 code pays about $111 (3.08 transitioned facility relative value units [RVUs] multiplied by the 2009...
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