CPT Coding Guidelines Review: Wound Repair (Closure)

This is a series of blogs about the importance of being familiar with CPT coding guidelines. Often there is extensive guidance preceding a subsection or range of codes for particular procedures, but coders are very busy so sometimes they jump right into the codes without taking time to review these guidelines, even though following or not following their direction could significantly affect the accuracy and comprehensiveness of coding.

This series is designed to help you become familiar with guidelines for significant procedures that you might not be acquainted with but do impact coding. The presentations are short and meant to generate awareness of the guidelines that are available in CPT rather than the application of guidelines to specific coding scenarios.

This installment of the series explores the guidelines related to CPT coding for wound repair (closure).

CPT Guidelines for Wound Repair (Closure)

Please watch this video to learn about the guidelines that provide direction in assigning CPT codes for wound repair (closure).

Take Aways

• Wound repairs are classified as simple, intermediate or complex
• Code selection is based on the total length of repair, measured in centimeters
• Wound repairs of the same classification and from the same anatomic groups are added together to calculate the total length of repair
• When more than one classification of wound is repaired, the more complicated repair is the primary procedure
• Simple and intermediate wound repairs are included in repairs of nerves, blood vessels and tendons
• Complex wound repairs may be reported in addition to codes for repair of nerves, blood vessels and tendons. Modifier -59 is added to the code for the complex repair

Test Your Knowledge

For detailed explanations of the quiz answers, please refer to the end of this blog post.

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Quiz Answers and Rationale

Question 1: The answer is intermediate. If a wound requires only single layer closure but is heavily contaminated and requires extensive cleansing and/or removal of particulate matter, this also qualifies as an intermediate repair.

Question 2: The answer is “Repairs need to come from the same classification and anatomic group to be added together to calculate the total length of repair”. Total length of repair is calculated by adding together the lengths of repairs of the same classification for the same anatomic grouping as listed in the code descriptors.

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The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.