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Wound Repair Codes In 2020: What You Should Know

The CPT codes in the “Repair (Closure)” section of the Current Procedural Terminology (CPT) book are intended for wound closure performed with “sutures, staples, or tissue adhesives.” Full guidelines for the use of these codes can be found on pages 89-90 of the 2020 CPT Professional book.1 Wound repair is typically classified as simple, intermediate or complex. In the 2020 CPT code set, there are updates from the American Medical Association (AMA) CPT Editorial Panel to the definitions of intermediate and complex repair.

As of January 1, 2020, intermediate repair requires either:

  • limited undermining and layered closure of subcutaneous tissue and/or superficial fascia, and skin closure; or
  • single-layer closure of a heavily contaminated wound that required extensive cleaning or removal of particulate matter. 

As of January 1, 2020, complex repair requires all three of the following:

  1. Meeting one of the two criteria of intermediate repair 
  2. Preparation of the wound performed by either creation of a limited defect for repairs or the debridement of complicated lacerations or avulsions
  3. One of the following:
  • exposure of bone, cartilage, tendon, or named neurovascular structure
  • debridement of wound edges
  • extensive undermining
  • involvement of free margins of the helical rim, vermilion border, or nostril rim
  • placement of retention sutures

Make sure you choose correctly. One must base the repair type on only the aforementioned criteria. In addition, it is important that your documentation supports the code selection. When using one of these repair codes, be sure the documentation includes everything listed above that is necessary for the selection of that code.

Dr. Lehrman operates Lehrman Consulting, LLC, is a consultant to the APMA Health Policy and Practice Department, serves as an expert panelist on Codingline, and is a Certified Professional Coder. Follow him on Twitter @DrLehrman.

Reference

1. American Medical Association. AMA CPT Professional 2020. Chicago: American Medical Association; 2019:89-90.

Current Procedural Terminology (CPT®) copyright 1966, 1970, 1973, 1977, 1981, 1983-2019 by the American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).  

Comments

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I don’t think that an intermediate repair requires undermining. The expanded explanation of undermining in the description of intermediate repairs is intended to identify the difference between limited undermining and extensive undermining to differentiate between an intermediate or a complex repair. Per CPT assistant, “The new 2020 guidelines highlight current techniques and offer clear differentiating language regarding the classifications of intermediate and complex surgical repair.”

CPT assistant also states, “The guidelines for simple repair closure have not been revised for 2020.” If their intention was to indicate that all intermediate repairs had to include undermining, meaning a two layer closure without undermining could not be reported as an intermediate repair, then the rules for reporting simple repairs would have had to have been changed to include 2 layer closures without undermining , which did not happen.

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In the bottom left corner of pg. 89 of the 2020 CPT book it says “limited undermining” is required with intermediate repair. I was the APMA staff liaison at the AMA CPT Editorial Panel meeting where we wrote this passage. It was not meant to be left open to interpretation, and the intention was to require limited undermining as part of intermediate repair.
Jeff Lehrman

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