2023 Wound Repair Guidelines

In 2020, the AMA/Specialty Society Relative Value Scale (RVS) Update Committee (RUC) Relativity Assessment Workgroup (RAW), identified a significant increase in the reported volume of intermediate and complex repair CPT codes. It was found that codes were correctly used when following lesion removal; however, RAW requested CPT Assistant to provide more education about the reporting of complex and intermediate repairs.

The CPT Assistant Editorial Board members worked with the Specialty Society to resolve member questions and decided to add clarifying language and code set guidelines for the intermediate and complex repair codes.

The AMA CPT updated the guidelines for the Integumentary System/Repair (Closure) subsection to clarify the coding of intermediate and complex repair of wounds in 2020. AMA CPT added more descriptive language to differentiate between intermediate and complex repairs.

SIMPLE REPAIR – A simple repair involves a superficial, epidermis, dermis, or subcutaneous tissues without the involvement of deeper structures. Simple repair requires a one-layer closure. These simple repair codes include hemostasis and local or topical anesthesia; therefore, hemostasis and local or topical anesthesia are not reported separately.

INTERMEDIATE REPAIR – Intermediate repair codes include limited undermining and provide a definition. An intermediate repair requires layered closure of one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia. This is, in addition to the epidermal and dermal closure, provided in the simple repair codes. Intermediate repairs include a limited undermining, which is less distant maximum width of the defect, measured perpendicular to the closure line, along at least one entire edge of the defect. Another example of an intermediate closure is a single-layered closure of a heavily contaminated wound that requires extensive cleaning or removal of particulate matter.

If an excision of an integumentary lesion is performed and an intermediate repair is performed, both the excision of the lesion and intermediate repair code would be reported. A modifier should not be required but may be payer specific.

COMPLEX REPAIR – A complex repair includes all the requirements of an intermediate repair plus at least one of the following:

• Repair of exposed bone, cartilage, tendon, or a named neurovascular structure
• Debridement of wound edges
• Extensive undermining
• Involvement of free margins of the helical rim, vermillion border, or nostril rim
• Placement of retention sutures

AMA CPT removed verbiage involving stents and scar revision from the complex repair guidelines. Preparation including creation of a limited defect for the repair, or debridement of the complicated laceration/avulsion is considered inherent to the complex repair.

Complex repair codes do not include the excision of benign lesions (11400-11446), malignant lesions (11600-11646), excisional preparation of the wound bed (15002-15005) or debridement of an open fracture or open dislocation.

For any excision performed requiring a complex repair as a closure, both the primary procedure and complex repair code would be reported. A modifier should not be required but may be payer specific.

For scar revisions, see Skin, Subcutaneous, and Accessory Structures, Excision – Benign Lesion subsection codes (11400-11471).

EXTENSIVE UNDERMINING

Anne Mettler-Huebner, MT(ASCP), CCS, CCS-P, CPC, CPC-I

Auditor | Excite Health Partners

Sources:

AMA CPT Assistant, November 2019 Page: 3 Category – Repair guideline revisions for intermediate

and complex repairs

AMA CPT 2023 Professional Edition, pages 90-91 – Repair (Closure)