Wound Care and Laceration Repair | CPT Coding Tips (2023)

Wound Care and Laceration Repair | CPT Coding Tips (1)

Q: Wound care and wound healing: "Could you share some wound care scenarios in the next webinar? I am aware of many of these questions as I am notCPC Practice Examsand I'm weak in that area. For example, an 11-year-old girl fell from a chair and sustained two 3cm lacerations to her left arm with embedded glass etc., she required complex repairs”.

A: The first thing I want to make clear as we dig into this question is that this is not really wound care. When it comes to wound care, we deal with the actual wound. Things like suctioning wounds and packing and all that. We call it reparation, and it is actually a reparation of wounds. A laceration is just that, it is an open cut in the skin and can go down several layers, to the bone in some situations.

When we get into coding repairs, there are actually three factors you need to consider. If you consult your CPT manual and go to the repair section in the integumentary section, you will find that there are three factors that will determine what repair you need. The three parts you need to know. First of all, you need to know the type of repair. Is it easy, medium or complex? When we say easy, intermediate, or complex, easy is exactly what it sounds like: easy. We are closing this backup right now. Usually we use sewing sutures, sometimes we use butterflies, but it can't be something as simple as Dermabond; If you read the guidelines, there it is.

(Video) Wound Care and Laceration Repairs | CPT Coding Tips

VIDEO: Wound Care and Laceration Repair | CPT Coding Tips

Advanced, because it's a bit more complex, we may need to do a multi-coat finish, we may need to get some dirt and debris out. A complex is exactly what it sounds like, really complex; We had to do a lot of undermining work. We had to get all that dirt and dead skin and all that other debris out of there. We need to do a layered finish, maybe we need to do rotations, something like that. So not only do we need to know what type and level and size, we also need to know where we are repairing, the anatomical site.

(Video) Laceration repair coding guidelines | laceration repair CPT codes.

The third part we need to know is the length of the crack, and your suppliers need to document the size of that crack. A good question I often get is, "What if my doctor didn't tell me the size of the laceration?" Well, you shot yourself in the knee. It's not that we can't code it, but we have to use the smallest size available because most say something like "2cm". If they didn't tell us the size, all we can know is that they had a laceration and we know we fixed it and we usually know how tall it was, but we don't know how big it was. a.

Let's see, I have a scenario here on my answer sheet that we'll discuss a bit later on the page:

Crack repair scenario

We have Martha. Martha is a 75 year old woman who lost her balance and fell. As she fell, she fell through the front door. She has glass embedded in her right forearm and then her right hip. She also sustained lacerations to her right cheek, shoulder and knee. So we have five different places that were injured; We have the forearm, the hip, the cheek, the shoulder, and the knee.

The cheek laceration was 2 cm long and we closed it with Prolene 6-0. The knee wound was 5.5 cm. The shoulder wound was 7 cm. With the shoulder wound, we had to cover the chamber. That should be it, any time you see a multi-layered bra, it should indicate that it will have at least one intermediate repair. That means they had to cover the shutdown; They may have had to close the muscle and then the skin, so they had to do multiple layers.

(Video) Simple laceration Repair CPT codes - simplify medical coding

His forearm was 11 cm long and the laceration on his hip was 4 cm long, both of which had to be cleaned and the glass removed. Once again, they had to do more than just a title. The hip injury was closed with a Vicryl and Prolene layered closure and her forearm was a complex closure with some debridement.

How to repair injuries

So when you code this, ask these three questions. I put mine on a small table to facilitate conversation.

  • Where were you?
  • Where were we?
    • We had cheek, shoulder, forearm, knee and hip.
  • How big were each one?
    • So I read the note and put the link to each one next to it.
  • What kind of closure was each of them?
    • Simple, medium or complex?

Wound Care and Laceration Repair | CPT Coding Tips (3)You can see that in my table I have two simple, two medium and one complex. If you look at these codes in the CPT manual, they are grouped together. if you do thatbubble and highlightDing, they're grouped into three bubbles and that's because they're grouping different areas of the body and they're saying, 'Oh, you code the arms and legs together.' They code the face and certain parts of the face together.” Things like that.

For simple repairs, the cheekbone falls into the second bubble in your book, and the knee falls into the first. So what we have, two simple repairs, are in two different anatomical locations, even according to CPT groupings, so we must have two codes. For intermediate repairs, shoulder and hip, both groups on the trunk or extremities. My shoulder and hip are out of my torso before I'm done.


If they are in the same bubble, we merge them together for repair purposes, not code them separately. Whoops, we coded the first two separately because they were in different bubbles. But here they are in the same bubble, they add up, so let's take the 7 cm from the shoulder, the 4 cm from the hip. We combined them into an 11 cm laceration with a security device and encoded the correct code for it, in this case it's 12034.

We have another closure, we have another, this complex closure. It is encoded only because it is a different level of closure. Think of it this way: you know where everyone has been, you need to see what the grade was: easy, medium, or hard? So you look at all your simples together, you look at all your intermediates together, you look at all your complexes together. And in each of them, do they all fall into the same anatomical grouping for the codes? If so, they will be added. Otherwise they are coded separately.

And how RVU?

Based on the UVR, the unit of relative value or weight given to this code is which pays more, which requires more work? And according to the RVUs, I've listed the answers for you in the order that they appear, and the complex solution goes first, and then you'll have these intermediate solutions, then you'll have these simple solutions. According to the guidelines, we also need a modifier of 59, and that's because the guidelines say, "When repairing more than one kind of wound, list the most complicated as the primary procedure and the least complicated as the secondary procedure, using the Use modifier 59.”

In fact, you would first create 13121 and the remaining four codes (12034, 13122, 12011, 12002) would each have a 59 modifier to show that they are distinct and meaningful. They're different, they meet different requirements and criteria, so the operator doesn't lump them all together and say, "You didn't load successfully."

(Video) Medical Coding | Laceration Repair Types Procedures | Emergency Department

This is what you will see in the examples as we talk about these examplesCPC exam and practice exams., these are really repairs and it comes down to these three questions, where in the body, how significant was the repair: simple, medium or complex; and how long, the length of the laceration?

Associated wound care and wound care stations:

  • CCO BHAT® Medical Coding Guide System
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  • ICD-10-PCS coding for measurement and monitoring with examples

Wound Care and Laceration Repair | CPT Coding Tips (4)


What is the coding rule for coding wound repairs? ›

Proper code selection when reporting a wound repair procedure requires examining the clinical documentation to determine three things: Layers involved (complexity of the repair: simple, intermediate, or complex); Location of the closed wound; and. Length, in centimeters, of the closed wound.

How do you code a laceration repair? ›

The code sets for laceration repair are: 12001-12007: simple repair to scalp, neck, axillae, external genitalia, trunk, and/or extremities (including hands and feet) G0168: wound closure using tissue adhesive only when the claim is being billed to Medicare.

When coding repairs of multiple lacerations in CPT what action should the coder take? ›

The length of multiple lacerations of the same type and defined as the same anatomic location are summed and reported with a single CPT code. For multiple lacerations of either different types or defined as different anatomic locations, report a code for each laceration.

What is the coding rule for coding multiple wounds? ›

In multiple wounds, sum the surface area of those wounds that are at the same depth, but do not combine sums from different depths. See CPT coding guidance for proper use of the coding. 2. Do not report 11042 -11047 in conjunction with 97597-97602 for the same wound.

What are the 5 steps to correct code? ›

A Five-Step Process
  1. Step 1: Search the Alphabetical Index for a diagnostic term. ...
  2. Step 2: Check the Tabular List. ...
  3. Step 3: Read the code's instructions. ...
  4. Step 4: If it is an injury or trauma, add a seventh character. ...
  5. Step 5: If glaucoma, you may need to add a seventh character.

What is the golden rule of medical coding? ›

The golden rule of healthcare billing and coding departments is, “Do not code it or bill for it if it's not documented in the medical record.” Providers use clinical documentation to justify reimbursements to payers when a conflict with a claim arises.

What are the 3 R's in medical coding? ›

From this basic process comes the three “R's” of consultation coding: request, render and reply.

What are the types of laceration repair? ›

Simple laceration repair includes superficial, single-layer closures with local anesthesia; intermediate laceration repair includes multiple-layer closures or extensive cleaning; and complex laceration repair includes multiple-layer closures, debridement, and other wound preparation (e.g., undermining of skin for ...

What are the three types of wound repairs? ›

There are three categories of wound healing—primary, secondary and tertiary wound healing.

How do you bill multiple laceration repairs? ›

Lengths from different anatomic sites should be billed individually. When more than one classification of wounds is repaired, the more complicated procedure must be always listed first. Modifier 51 should be added to the second procedure to indicate that multiple procedures were performed.

Can you code the same CPT code twice? ›

Identical services being repeated should be submitted using CPT modifier 76, 77, or 91. CPT Modifier 76: 'Repeat procedure by same physician: The physician may need to indicate that a service was repeated the same day subsequent to the original service.

What are the six specific actions in the coding process? ›

6 Key Steps in the Medical Coding Process
  • Action 1. Abstract the documentation. ...
  • Action 2. Query, if necessary. ...
  • Action 3. Code the diagnosis or diagnoses.
  • Action 4. Code the procedure or procedures. ...
  • Action 5. Confirm medical necessity. ...
  • Action 6. Double-check your codes.
4 Dec 2019

What is the golden coding rule number 1? ›

Here is the summary: Rule 1: Follow a consistent coding standard. Rule 2: Name things properly, long variable and function names are allowed. Rule 3: Be expressive, write code as you speak, and be optimally verbose.

What are the basic coding rules? ›

What Are Coding Rules and Guidelines?
  • Safe: It can be used without causing harm.
  • Secure: It can't be hacked.
  • Reliable: It functions as it should, every time.
  • Testable: It can be tested at the code level.
  • Maintainable: It can be maintained, even as your codebase grows.
  • Portable: It works the same in every environment.

What is the first rule of coding? ›

Description. 1st Rule Of Programming: If It Works Dont Touch It.

What are the 7 steps of coding? ›

Let us turn to the programming process. Developing a program involves steps similar to any problem-solving task.
The Programming Process
  • Defining the problem.
  • Planning the solution.
  • Coding the program.
  • Testing the program.
  • Documenting the program.

What are the 7 steps to accurate coding? ›

7 steps for accurate surgical coding:
  • Review the header of the report.
  • Review the CPT code book.
  • Review the documentation.
  • Make preliminary code selection.
  • Review the guidelines for preliminary codes.
  • Review policies and eliminate the extras.
  • Add any needed modifiers.
27 Apr 2021

What are 10 things you should know before coding? ›

What Are 10 Things You Should Know Before Coding?
  • #1 Set Up Goals.
  • #2 Practice Patience.
  • #3 Pay Close Attention to the Basics.
  • #4 Practice Coding By Hand.
  • #5 Learn By Doing, Not Memorizing.
  • #6 Become Your Own Problem-Solver.
  • #7 It's Okay to Ask for Help.
  • #8 Make Mistakes, Then Learn from Them.
28 Jul 2020

Do medical coders have to memorize all codes? ›

First, it's important to know that medical coders don't actually have to memorize all of these codes. Instead, they utilize reference codebooks and software programs to ensure accurate coding assignments are made.

What should a medical coder not do? ›

Here are some of the most common mix-ups to avoid in medical coding.
  • Unbundling codes. ...
  • Upcoding. ...
  • Failing to check National Correct Coding Initiative (NCCI) edits when reporting multiple codes. ...
  • Failing to append the appropriate modifiers or appending inappropriate modifiers.
14 Jul 2021

How do you pass the medical coding exam? ›

Study Tips to Pass the CPC Exam on Your First Try
  1. Plot Your Course to Medical Coding Certification. ...
  2. CPC Exam Basics. ...
  3. Learn What to Study for the CPC Exam. ...
  4. Know the Official Code Guidelines. ...
  5. Prep Your Medical Code Books. ...
  6. Practicing for the CPC Exam. ...
  7. Exam Week. ...
  8. Certification Exam Eve.

When do you use modifier 32? ›

When should Modifier 32 be used? Modifier 32 is used only whenever a service has to be extended to a third party entity or in the case of Worker's Compensation or some other such official entity. However, modifier 32 may never be used when the patient wishes to seek a second opinion from a different doctor.

Why are modifiers used? ›

Modifiers indicate that a service or procedure performed has been altered by some specific circumstance, but not changed in its definition or code. They are used to add information or change the description of service to improve accuracy or specificity.

What is the format of CPT modifiers? ›

CPT Modifiers are always two characters, and may be numeric or alphanumeric. Most of the CPT modifiers you'll see are numeric, but there are a few alphanumeric Anesthesia modifiers that we'll look at toward the end of this course. CPT modifiers are added to the end of a CPT code with a hyphen.

What are the 4 types of laceration closures? ›

Skin can be closed with permanent sutures or staples. Depending on the individual wound, simple sutures, horizontal or vertical mattress sutures, half-buried mattress sutures, or running sutures can be used.

What are the 7 types of wounds? ›

Types of Wounds
  • Penetrating wounds. Puncture wounds. Surgical wounds and incisions. Thermal, chemical or electric burns. Bites and stings. Gunshot wounds, or other high velocity projectiles that can penetrate the body.
  • Blunt force trauma. Abrasions. Lacerations. Skin tears.

What are the 4 types of wound? ›

  • Class 1 wounds are considered to be clean. They are uninfected, no inflammation is present, and are primarily closed. ...
  • Class 2 wounds are considered to be clean-contaminated. ...
  • Class 3 wounds are considered to be contaminated. ...
  • Class 4 wounds are considered to be dirty-infected.
28 Apr 2022

What is the proper sequence for wound repair? ›

When the skin is injured, our body sets into motion an automatic series of events, often referred to as the “cascade of healing,” in order to repair the injured tissues. The cascade of healing is divided into these four overlapping phases: Hemostasis, Inflammatory, Proliferative, and Maturation.

What are the 5 types of wounds? ›

The five types of wounds are abrasion, avulsion, incision, laceration, and puncture. An abrasion is a wound caused by friction when a body scrapes across a rough surface. An avulsion is characterized by a flap. An incision is a cut with clean edges.

Can you add repairs of different classifications together? ›

Do not add lengths of repairs from different groupings of anatomic sites (e.g. face and neck). Also, do not add together lengths of different classifications (e.g. intermediate and complex repairs).

What is the time limit for laceration repair? ›

Clean, uninfected lacerations on any part of the body in healthy patients may be closed primarily for up to 18 hours following the injury without a significant increase in the risk of wound infection.

What is considered a complex laceration repair? ›

A complex wound repair code includes the repair of a wound requiring more than a layered closure (e.g., scar revision or debridement), extensive undermining, stents, or retention sutures.

Can RT and LT modifier be used together? ›

Do not use the combination RTLT modifier on the same claim line and bill with 2 units of service (UOS). Claim lines for HCPCS codes requiring use of the RT and LT modifiers, billed without the RT and/or LT modifiers or with the RTLT on a single claim line, will be rejected as incorrect coding.

What happens if you use the wrong CPT code? ›

Claims for services are then submitted to insurance companies, Medicare, Medicaid, etc. with these codes. Inaccurate medical coding will cause your reimbursements to get delayed, denied, or only partially paid.

What will happen if the diagnosis is coded incorrectly? ›

Codes have slight variances between the specificity of a diagnosis. Inaccurate coding of the specifics during diagnosis could result in improper patient care at another practice, or for a particular service. A missing 2-digit modifier for a knee injury could result in having an MRI study conducted on the wrong knee.

What are the 3 types of coding techniques? ›

Data compression (or source coding) Error control (or channel coding) Cryptographic coding.

What are the 4 steps of coding? ›

Here's how we can do so in four major steps.
Computer Programming in 4 Steps
  • Step 1: Identify the problem. ...
  • Step 2: Find a solution. ...
  • Step 3: Code it. ...
  • Step 4: Test it.
13 Jul 2022

What are the 8 steps to accurate coding? ›

Terms in this set (8)
  • Identify the main term(s) in the diaagnostic statement.
  • Locate the main term(s) in the Alphabetic Index.
  • Review any sub terms under the main term in the Index.
  • Follow any cross-reference instructions, such as "see."
  • Verify the code(s) selected from the Index in the Tabular List.

What are the three classifications of wound repair? ›

There are three categories of wound healing—primary, secondary and tertiary wound healing.
It differs from primary healing in several respects, i.e. in secondary healing:
  • Inflammatory reaction is more intense.
  • Much larger amounts of granulation tissue are formed.
  • Wound contraction is much more.

What are wound repairs classified? ›

Wound repairs are classified as simple, intermediate, or complex.

What are the five 5 basic principles of the management of a wound or laceration? ›

In this article, the authors offer five generalisable principles that colleagues providing community care can apply in order to achieve timely wound healing: (1) assessment and exclusion of disease processes; (2) wound cleansing; (3) timely dressing change; (4) appropriate (dressing choice; and (5) considered ...

What are the 4 steps to caring for a wound? ›

4 Steps to Treat Abrasions at Home
  1. Assess the Wound.
  2. Clean the Affected Area.
  3. Stop Mild Bleeding.
  4. Dress the Wound.
5 Oct 2017

What are the 3 types of wounds? ›

Causes and Types of Wounds
  • Stab wounds (trauma from sharp objects, such as knives)
  • Skin cuts.
  • Surgical wounds (intentional cuts in the skin to perform surgical procedures)
  • Gunshot wounds (wounds resulting from firearms)

What are the 4 stages of tissue repair? ›

Wound healing is classically divided into 4 stages: (A) hemostasis, (B) inflammation, (C) proliferation, and (D) remodeling. Each stage is characterized by key molecular and cellular events and is coordinated by a host of secreted factors that are recognized and released by the cells of the wounding response.

What are the 6 steps of coding? ›

6 Key Steps in the Medical Coding Process
  • Action 1. Abstract the documentation. ...
  • Action 2. Query, if necessary. ...
  • Action 3. Code the diagnosis or diagnoses.
  • Action 4. Code the procedure or procedures. ...
  • Action 5. Confirm medical necessity. ...
  • Action 6. Double-check your codes.
4 Dec 2019


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2. Wound Care Diagnosis- Medical Coding for Healing Wounds
3. Integumentary system Skin Repair/Closure CPT coding. #Skinrepaircodingmalayalam
4. Why Would You Need to Know Wound Care Coding?
(Contempo Coding)
6. CPT Simple, Intermediate & Complex Repair Codes in Medical Coding
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