medical coding question

Question

a patient comes in for multiple lacerations. The size of the wounds and closures are the following:

Left Leg – 5 cm wound closed with a single layer closure

Chest – 5 cm wound closed with a layered closure of subcutaneous and superficial fascia tissue

Answer 1

We can find the codes and guidelines for these closures under the Repair (Closure) subheading in the integumentary category of the Surgery section. (Page 106 in the Professional Edition of the CPT 2022 codebook from the AMA)

First we need to determine if the repairs are simple, intermediate or complex. A simple repair is used when the wound is superficial and requires a simple one layer closure. Our left leg wound repair fits the definition of a simple repair. An intermediate repair requires layered closure of one or more of the subcutaneous tissue or non-muscle (superficial) fascia layers. Because the chest wound involves these deeper layers, it will meet the requirements for an intermediate repair code.

We want to list the codes in order of complexity, with the most complex code first. To find the right code for the chest wound repair, see the list of intermediate repair codes. They are grouped first by anatomical site, then by the length of the repair. 12031-12037 are the codes used for intermediate repairs of the trunk. This wound is 5cm in length, so 12032 will be the appropriate code.

Next we code the simple closure. They are grouped in the same manner as the intermediate codes, by anatomic site, then by length. We need the code for a simple repair of superficial wounds of extremities; 2.6cm to 7.5cm. 12002 is the correct code.

The next step is to check our guidelines for listing services at the time of wound repair. It isn't always appropriate to use more than one code per session, per day, for repairs on the same patient by the same provider. We need to let the insurance company know that each of these repairs is a distinct and separately identifiable procedure so they don't reject or deny the claim. Our guidelines tell us that "when more than one classification of wounds is repaired" ( eg, simple and intermediate) "list the more complicated procedure as the primary procedure and the less complicated as the secondary procedure using modifier 59." Modifiers can be found in Appendix A of the CPT codebook. Modifier 59 indicates that two services, which are not normally reported together, are appropriate under the circumstances. Since our documentation supports that we indeed have two separate wounds of different classifications and at different anatomical sites, these codes are appropriate together with modifier 59 added.

Our codes would look like this: 12032, 12002-59.