Closures: 12001 or 13100? Consider More Than Layers to Code Correct Closure Level

Follow our tips to dig deeper and find the differences between 'simple,' 'intermediate,' and 'complex.'

All closures aren't created equal; one of the nuances of coding these procedures is knowing how to distinguish one type from another. Read on for our experts' advice on how to assess the three closure levels and assign the best codes.

Remember 'Simple' Doesn't Mean 'Easy'

A simple repair involves primarily the dermis and epidermis. It might involve subcutaneous tissues, but not deep layers.

Draw the line: How do you know when a closure might involve subcutaneous layers but is still considered a simple repair? Your provider's documentation is the key. The difference is whether the wound is closed in layers or just a single layer, experts note. The provider might decide to include the subcutaneous layer in the closure but does so by bringing the needle through the dermis into the subcutaneous and back. That results in a single-layer closure rather than closing the subcutaneous layer first and then the dermis/epidermis second in separate closure techniques.

But "simple" doesn't mean the repair is something anyone could do. Simple repairs involve one-layer closure, which helps set them apart from a standard E/M procedure. Simple repair also includes "local anesthesia, and chemical or electrocauterization of wounds not closed," says Dilsia Santiago, CCS, CCS-P, a coder in Reading, Pa.

For example, if your dermatologist uses adhesive strips to close a laceration, consider it an E/M service that you'll report with the best-fitting choice from CPT codes 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient) or 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient). Most Steri-strip applications are done by nursing staff; but even if the physician applies them, they're included in the E/M service .

If, however, your dermatologist uses sutures, staples, or tissue adhesives to close the laceration, consider it a separate procedure. Choose your code from 12001-12007 (Simple repair of superficial wounds of scalp, neck, axillae, eternal genitalia, trunk and/or extremities [including hands and feet]) or 12011-12018 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes), based on the lesion's location and size.

Measuring tip: For excision of soft tissue tumors, measure the longest dimension of an oblong mass, according to John P. Heiner, MD, professor at University of Wisconsin Hospital and Clinics in Madison.

Medicare exception: Guidelines change when your physician performs a single-layer laceration repair on a Medicare patient. You'll report G0168 (Wound closure utilizing tissue adhesive[s] only) instead of reporting standard CPT codes. If your physician uses sutures instead of tissue adhesive for Medicare patients, turn back to the standard suture/repair codes.

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Jerry Salley, CPC, has over six years' experience writing about coding, focusing especially on ophthalmology coding with The Coding Institute's Ophthalmology Coding Alert . He has also written about optometry, gastroenterology, dermatology, audiology, and urology coding, as well as Joint Commission accreditation, healthcare human resources, and behavioral healthcare reimbursement issues. A graduate of Furman University, Jerry is a certified professional coder through the American Academy of Professional Coders.