procedure code and description
12001 – Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less – average fee payment- $90-$100
Simple repair codes 12001 –
Procedure 12021 are used when the wound only involves the epidermis and/or dermis. The wound does not extend into the deeper subcutaneous tissues. The repair is a simple one layer closure and may be performed with the use of tissue adhesives, staples or suture material.
Effective Jan. 1, 2005, code G0168 wound closure using adhesives only, was changed to an APC status indicator of “N” and will no longer be paid separately. A simple repair reported with code only G0168 will not be reimbursed. The code for the simple repair is assigned from code range 12001-12018 and an additional code for the wound adhesive G0168 may also be assigned.
Laceration Repair Examples:
Example 1: A patient was the victim of a knife attack and has 5 lacerations. He has a 2 cm laceration to the scalp, a 3 cm laceration on the right thigh and two lacerations to the chest measuring 4 cm and 6 cm. There is also a 4 cm complicated laceration of the face.
The physician repairs the scalp with single layer closure. The wounds to the chest and thigh are deeper and require repair of the subcutaneous tissues and skin in a layered fashion. The facial laceration required extensive undermining and approximation was extremely difficult.
Answer: One simple repair was performed to the scalp measuring 2 cm, 12001. Two intermediate repairs to the chest and one of the thigh measuring a total of 13 cm, 12035. One complex repair to the face measuring 4 cm, 13132.
Example 2: An infant sustained a 1 cm laceration just above the eyebrow. The wound was cleaned and Dermabond was applied.
Answer: Assign code 12011. An additional code of G0168 may be assigned.
When you code for the use of tissue adhesives, including Dermabond; Medicare has its own guidelines for reporting this procedure that you need to follow to be reimbursed. You should report G0168 for Medicare patients only. If you are reporting the procedure for a non-Medicare patient, you should use the CPT code that is the equivalent and that is 12001-12018 series (Simple repair of superficial wounds …).
NCCI Manual – ATT
Debridement necessary to accomplish these tissue transfer procedures is part of the column 1 procedure performed. Separate debridement Procedure codes (11000-11042) or repair Procedure ® codes (12001-13160) would be inappropriately reported with these Procedure ® codes (14000-14350) for the same lesion/injury.
Wound repairs are also classified by their anatomic location. Simple repairs (Procedure 12001 – 12018) have two major groups of locations that are categorized together. Any repairs in these areas of the same type should have their lengths summed. For example, if separate laceration repairs of a hand and foot are done, their lengths should be summed and reported as one repair.0 Simple repairs:
• Scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet). For example, a simple hand laceration of 2.5 cm or less is reported with Procedure 12001, and if 2.6 cm – 7.5 cm with Procedure 12002.
• Face, ears, eyelids, nose, lips and/or mucous membranes Intermediate repairs (12031-12057) have three major groups of locations that are categorized together:
• Scalp, axillae, trunk and/or extremities (excluding hands and feet)
• Neck, hands, feet and/or external genitalia
• Face, ears, eyelids, nose, lips and/or mucous membranes
Keep in mind that location really does matter! A 5.2 cm scalp laceration coded as 12002 yields 2.1 RVUs while a 5 cm laceration of the forehead is reported with code 12014 and produces 2.5 RVUs.
Another tip for reporting this claim to Medicare is you may only use G0168 for Dermabond-only laceration repairs in both the inpatient and outpatient settings. If sutures or staples were also used you will have to report this as a layered laceration code on your medical billing form.
Something you may not be aware of is that Medicare assigns a payment status indicator of “N” to G0168, meaning it represents an incidental service. You can report the code but you won’t receive any reimbursement for it from Medicare payers.
Private payers will have different guidelines, a quick check with the payers to see if they follow Medicare guidelines for this type of procedure will let you know whether or not to expect a reimbursement for the service.
UNITS OF SERVICE: * Unit of 1 should be report in FL 46 for 12001 through 13160
CCI EDITS AND MODIFIERS:
* CCI Edits are present for these procedures when multiple wound repairs performed – EXAMPLE – Patient presents with 1.3 cm scalp and 1.2 cm cheek lacerations. – simple repairs performed – 12001 and 12011-59.
* Appropriate appending of modifier 59 to show each repair is separate and distinct based upon documentation and CPT code guidelines
* Do not reporting anatomical modifiers LT, RT, FA-F9, TA-T9 for CPT codes 12001 through 13160. With multiple body categories within each narrative, does not give greater anatomical specificity. If modifier needed with CCI – report 59 on the lesser code.
Coding examples
Lips and back are not grouped together. CPT code 12001 is the stand-alone code for scalp, neck, axillae, external genitalia, trunk, and/or extremities (including hands and feet). CPT code 12011 is the stand-alone code for the face, ears, eyelids, nose, lips, and/or mucous membranes. Therefore, you are not allowed to add up the sum of these simple repairs. You are instructed to code them separately. 12002 and 12011 (with modifier 51 added to this second code) are the correct codes for this case study.
A four-year-old patient came into the emergency department after she fell off a swing and scraped her arm. The physician examined the abrasion and documented that she required a 4.3 cm simple repair on her left arm.
a. 12001
b. 12002
b. 12013
c. 12014
A 6-year-old girl fell on a nail while her father was repairing a shelf in the garage. The nail is stuck in her right hand with minimal bleeding. The patient had a tetanus shot about 18 months ago. The physician performed a 1.2 cm intermediate repair to heal the puncture wound and applied an adhesive strip to a small abrasion on her forearm.
a. 12041
b. 12041-51
c. 12041-RT, 12001-51
d. 12001-51
A 43-year-old woman was hurt at work while using a box cutter to open a package. Patient was ordered by her work to go to the Emergency Department to have her incision evaluated. The physician performed a 1.7 cm one-layer closure on her left hand.
a. 12031
b. 12002
c. 12011
d. 12001
