FAQs - Coding for Intermediate and Complex Repairs in 2020 and beyond
Q: Are there any changes to the Simple Repair guidelines?
A: No, the simple repair guidelines will remain unchanged for 2020 and beyond.
Q: How should I code a nasal tip excision, for which the defect is repaired with a linear layered closure (3 cutaneous and 5 super-ficial sutures) totaling 1.5 cm in length and extended over visibly exposed lateral alar cartilage. How would I code this service? You report CPT 13151.
A: You should report this with CPT code 13151. The criteria for complex repair have been met in that you performed a layered closure, and the defect has exposed cartilage have been met. Code selection is determined by location (nose) and repair length (1.1 to 2.5 cm).
Q: A squamous cell carcinoma is excised from an elderly woman’s severely photodamaged, atrophic extensor forearm. A linear repair is performed. However, closure is a challenge, as the atrophic skin fails to support buried dermal stitches. Consequently, you close the wound with a series of retention sutures combined with several surface interrupted stitches to better appose the skin edges. Since you placed retention sutures you report a complex repair.
A: No. According to the 2020 intermediate and complex repair guidelines, placement of retention sutures alone does not qualify for a complex repair. To report a complex repair, one must also satisfy a criterion for intermediate repair, such as layered closure. In this case, a layered repair was not performed. Consequently, reporting of complex or intermediate repair is not appropriate. The procedure would appropriately be reported as a simple repair.
Q: Patient presents with a laceration after a fall on the pavement. Debris and pavement particles from the wound are removed and scrubbed out. A single layer of interrupted stitches is performed, and an intermediate repair is reported.
A: Yes. Although no layered closure was performed, extensive particulate matter was removed from the particle-contaminated wound. This is one of the requirements that must be met in as described in the definition of intermediate repair. Hence, this procedure is correctly reported as an intermediate repair.
Q: A tumor is excised from the nose alar rim and the defect is linearly repaired with buried dermal stitches followed with a second layer of surface stitches. No under-mining is done. You report a complex repair.
A: Yes. The layered repair involved the free margin of the nostril (alar) rim. This satisfies criteria for complex repair.
Q: A fusiform excision on the cheek measures 1.5 cm perpendicular to the layered repair line of closure. Undermining is done along both entire edges of the fusiform defect, 1.0 cm on one side and 0.5 cm on the opposite side. The combined distance of undermining equals the maximum defect width of 1.5 cm. A complex repair code is reported.
A: Although the total diameter of undermining equals the maximum width of the surgical defect (1.5 cm), neither side was undermined to at least 1.5 cm. To meet the definition of complex repair, undermining would have to be done to at least a 1.5 cm diameter along one entire side of the surgical line of closure.
