Coding Excisions and Wound Repairs

by  Codapedia
January 6th, 2016

By: Allison Singer, CPC, CPMA (Oct/15/2015) 

Chart audits frequently examine coding associated with lesion removals and wound repairs. In order to assign the appropriate procedure code, certain documentation must be included in the medical record, such as lesion type, excision size, wound repair, and location. Without these important details, providers run the risk of downcoding or filing inaccurate claims based on poor documentation.

This article will focus on the ins and outs of lesion removals, and some of the common coding pitfalls that are frequently associated with these procedures.

Coding Excisions

An excision is the surgical removal or resection of a diseased part by an incision through the dermal layer of the skin, and may be performed on either benign or malignant skin lesions. The different types of benign skin lesions include: moles, epidermoid or sebaceous cysts, non-cancerous neoplasms, integumentary lipomas, nevi, warts, seborrheic keratoses, and more. Malignant lesions include basal and squamous cell carcinoma, melanomas, and metastatic skin lesions. 

Excisions for benign lesions (11400-11446) and malignant lesions (11600-11646) are minor surgical procedures with a 10-day global period. Local anesthesia, a biopsy of the lesion, and an evaluation and management (E/M) examination are all included in the global surgical package. 

Note: Wound repairs must normally be performed to correct the defect caused by the surgical excision of a lesion. 

All simple wound repairs are included in the surgical package of the excision, and may not be reported separately. A simple wound repair requires only a one layer of the epidermal/dermal skin layers, or subcutaneous tissues. 

The following steps will help you to select the appropriate code for an excised lesion: 

            Step 1 – Determine the type of lesion from the pathology report

            Step 2 – Identify the anatomic site 

            Step 3 – Calculate the size of the excision (lesion size + margins)

             Step 4 – Assign a procedure code based on data from steps 1 thru 3 

            Step 5 – Assign an additional code for intermediate or complex repairs

Note: If the wound repair or closure requires an Adjacent Tissue Transfer or Rearrangement (such as a Z-plasty or a rotation flap), the excision is not reported separately, but is included in the surgical package for the Adjacent Tissue Transfer or Rearrangement (See 14000-14350.). 

Coding Wound Repairs.

All excisions include a simple closure as part of the surgical package, and therefore, may not be billed separately. However, for excisions that require more than a simple closure, coders can report either an intermediate (12031-12057) or complex (13100- 13160) repair, in addition to the excision. Wound repair codes should only be used when the physician uses sutures, staples, or tissue adhesives to close a wound. If a physician only uses adhesive strips to close a wound, the repair must be reported using an E/M code (99201-99499) instead. 

The following steps will help you to code for a wound repair: 

            Step 1 – How was the wound closed? 

            Step 2 – What type of closure did the physician perform? 

            Step 3 – On what anatomic site was the wound repair performed? 

Simple

            Intermediate

            Complex

            Step 4 – Assign a repair code based on the total lengths of all wound repairs that are performed in the same anatomic group under the same classification (intermediate or complex). 

                        For Example:

                        A 2.5 cm intermediate repair on the right shoulder, a 1.0 cm intermediate repair on the                          scalp, and a 1.0 cm  intermediate repair on the left shoulder would be coded as12032,                          Wound Repair, Intermediate, 2.6 cm to 7.5 cm. 

Adjacent Tissue Transfer or Rearrangement

For complex excisions that are very large or in areas with little to no margins available, an intermediate or complex wound repair may not be possible. Other wound repairs commonly performed with excisions are Adjacent Tissue Transfers or Rearrangements (14000-14350). An Adjacent Tissue Transfer or Rearrangement (sometimes referred to as a reconstructive repair) may include one of the following: 

Adjacent Tissue Transfers or Rearrangements involve the creation of two defects. The primary defect is created when the lesion or skin anomaly is excised. The secondary defect is produced by the surgical creation of a tissue flap that is used to close the primary defect. Tissue flaps are created by surgically freeing healthy skin and underlying subcutaneous tissue and/or fascia adjacent to or near the wound site, leaving the base of the tissue flap connected to one or more borders of the donor site. The tissue flap is then used to cover the wound created by the excision. 

Note: If a skin graft or additional flap is necessary to close the secondary defect, report an additional code from 15100-15431. 

Code selection is based on two factors: anatomic site and the area of the total body surface created by the primary and secondary defects. To assign the appropriate procedure code, follow the steps below: 

            Step 1 – Determine the anatomic site of the procedure 

 Note: For code 14350, Filleted finger or toe flap, it is not necessary to calculate the area of the defects in order to assign the code.           

            Step 2 – Calculate the total area of the defects to select the appropriate code                                                             [Total Body Surface (Area of 1º Defect + Area of 2º Defect)] 

            For Example:

            Primary Defect: 2.0 cm x 2.0 cm = 4.0 sq cm

            Secondary Defect: 2.0 cm x 4.0 cm = 8.0 sq cm

            Total Area (Primary + Secondary): 4.0 sq cm + 8.0 sq cm = 12.0 sq cm

 

Modifiers with Multiple Procedures

With some excisions, it may be necessary to report more than one procedure code in order to capture the full services performed. When multiple surgical procedures are performed on the same patient, by the same physician, on the same day, during the same encounter, add modifier 51 (Multiple Procedures) to all subsequent procedures. 

            For Example:

            A patient has a 2.0 cm benign lesion removed from her neck. The physician also performs a                 2.5 cm intermediate wound repair on the excised site. The physician’s services are reported                 as 11420 and 12001-51. 

Note: Remember not to add modifier 51 to any procedures that are classified as add-on procedures or modifier 51 exempt. 

If multiple procedures are performed on the same day, but the excisions or wound repairs involve different anatomic sites, it may be necessary to add modifier 59 (Distinct Procedural Service) to the subsequent procedures. Modifiers with Multiple Procedures (Continued) If the patient is already in a post-operative (post-op) period when the excisions or wound repairs are performed, one of the following modifiers may be required for accurate coding: 

For separate, unrelated, E/M service performed on the same day as a surgical procedure, do not forget to add one of the following modifiers to the E/M code: 

References:

Coding Excisions and Wound Repairs. (2016, January 6). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/coding-excisions-and-wound-repairs-28093.html

© InnoviHealth Systems Inc

Article Tags  (click on a tag to see related articles)


Publish this Article on your Website, Blog or Newsletter

This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.

If you would like a specific article written on a medical coding and billing topic, please Contact Us.


contact

innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)
Email:
free demo
request yours today
pricing
for any budget
sign IN
welcome back!

Thank you for choosing Find-A-Code, please Sign In to remove ads.