2022 simple repair guideline updates
Derm Coding Consult
By Faith C. M. McNicholas, RHIT, CPC, CPCD, PCS, CDC, Manager, Coding & Reimbursement, December 1, 2021
Academy coding staff address important coding topics each month in DermWorld Coding Consult. Read more Derm Coding Consult articles.
The Integumentary System, Repair (Closure) guidelines have been revised. Before 2022, the simple repair guidelines stated that simple repair included local anesthesia and chemical or electrocauterization of wounds not closed. The American Medical Association CPT Editorial Board (AMA CPT®) indicated that this statement was often misinterpreted to mean that simple repair codes may be reported when electrocauterization is used in place of sutures.
To address the issue, the guidelines have been revised to clarify that chemical cauterization, electrocauterization, or wound closure using adhesive strips as the sole repair material does not constitute a simple repair that can be reported with an appropriate evaluation and management (E/M) code.
The 2022 guideline now reads as follows:
Simple repair is used when the wound is superficial (e.g., involving primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures) and requires simple one-layer closure. Hemostasis and local or topical anesthesia, when performed, are not reported separately.
Coding resources
Stay current on coding topics with the Academy’s coding resources.
How to use simple repair codes
Simple repair codes, 12001-12018, are reported for the repair of superficial wounds with partial- or full-thickness damage to the skin (epidermis/dermis) and possibly the subcutaneous tissue occur without the involvement of the deeper structures such as muscles. The repair requires a simple one-layer closure. The intra-service work for simple repair includes performance, administration of anesthesia, and chemical or electrocauterization of wounds to be repaired. The AMA states that CPT® codes 12001-12018 are used to designate wound closure utilizing sutures, staples, or tissue adhesives (e.g., 2-cyanoacrylate), either singularly or in combination with each other, or in combination with adhesive strips.
Coding tip
Wound closure solely with tissue adhesive are reported to Medicare with HCPCS Level II code:
G0168 Wound closure utilizing tissue adhesive(s) only.
Please check directly for specific coding guidance from private payers.
Although most dermatologic surgical procedures indicate that a simple repair when performed is included in the procedure and not separately reported, there may be rare circumstances when a simple repair can be reported as a separate procedure. For example, a dermatologist closing a laceration (wound not created through a surgical incision) using simple repair can be reported with the appropriate simple repair code (12001-12018).
Documentation requirements for all repair/closure procedures
Accuracy in repair code selection is dependent on detailed medical record documentation. To determine the appropriate repair code, one must examine the clinical documentation to establish three important elements:
1. Determine the complexity of the repair/closure
How many layers are involved in the closure/repair? Identifying this information will help determine the complexity of the repair as either simple, intermediate, or complex.
Repair codes are divided into three categories:
Simple repairs (12001-12018): reported when the wound is superficial (e.g., involving primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures) and requires simple one-layer closure.
Intermediate repairs (12031-12057): includes the repair of wounds that, in addition to the above, require 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.
Complex repairs (13100-13160): includes the repair of wounds that, in addition to the requirements for intermediate repair, require at least one of the following: exposure of bone, cartilage, tendon, or named neurovascular structure; debridement of wound edges (e.g., traumatic lacerations or avulsions); extensive undermining (defined as a distance greater than or equal to the maximum width of the defect, measured perpendicular to the closure line along at least one entire edge of the defect); involvement of free margins of helical rim, vermilion border, or nostril rim; placement of retention sutures.
Derm Coding Consult
Get more coding tips.
2. Identify the location of the repair/closure
Identify the anatomic location of the repair. This is important because the CPT code descriptors for repair codes are classified according to anatomic location. Note that these categories are not identical for each level of repair as shown in the table below.
| Type of repair | Anatomic locations | Code series |
|---|---|---|
Simple |
Scalp, neck, axillae, external genitalia, trunk, and/or extremities |
12001-12007 |
Face, ears, eyelids, nose, lips, and/or mucous membranes |
12011-12018 |
|
Intermediate repairs |
Scalp, axillae, trunk, and/or extremities (excluding hands and feet) |
12031-12037 |
Neck, hands, feet, and/or external genitalia |
12041-12047 |
|
Face, ears, eyelids, nose, lips, and/or mucous membranes |
12051-12057 |
|
Complex repairs |
Trunk |
13100-13102 |
Scalp, arms, and/or legs |
13120-13122 |
|
Forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet |
13131-13133 |
|
Eyelids, nose, ears, and/or lips |
13151-13153 |
3. Determine the length, in centimeters, of the closed/repaired wound
The coding guidelines further state that the final code selection is based on the size of the repair as indicated in the code descriptor. The length of the wound repaired must be measured in centimeters and documented in the medical record whether curved, angular, or stellate. If the wound measurements are documented in inches or millimeters, instead of centimeters, convert the measurements to centimeters before selecting the appropriate code.
Avoid common coding mistakes by remembering the three key components for coding wound repair correctly: complexity, location, and length.
For more information on the new and revised guidelines, review the Academy’s Coding and Billing Manual, and the Academy’s Principles of Documentation in Dermatology.
For more information on reporting repair services, check out Derm Coding Consult, and at the AADA Coding Resource Center.
Additional DermWorld Resources
In this issue
The American Academy of Dermatology is a non-profit professional organization and does not endorse companies or products. Advertising helps support our mission.
Opportunities
