Dermatology Coding Alert: Layers with Complexity Gets You More Money

Dr. Purushothaman
September 12, 2013

Find the answers to 'simple,' 'intermediate,' and 'complex' closures.
Receiving the wrong repair code could practice a lot -- for example, you'd miss $214 for a 2.5 cm complex trunk closure incorrectly billed as a simple trunk repair. And since that certain procedures contain simple closure but let you to distinctly bill for complex closure, you stand to lose even more if you don't differentiate repair complexity.
Read on for this expert dermatology medical billing and coding advice on how to examine the three closure levels and give the best codes to earn your practice the pay you are worthy of.
Simple Repair: Always Follow the Layers & Not the Depth
A simple repair includes mainly the dermis and epidermis. It may include subcutaneous tissues, but not deep layers.

Draw the line: How will you make out when a closure may involve subcutaneous layers, however, is still taken as a simple repair? The difference is whether the dermatologist closes the wound in several layers or just one. If the dermatologist doesn't close the subcutaneous layer first, trailed by a separate dermis/epidermis closure, you have a simple repair.
Remember: Simple repair also involves local anesthesia, plus chemical or electrocauterization of unclosed wounds.
Select your code from 12001-12007 (Simple repair of superficial wounds of scalp, neck, axillae, eternal genitalia, trunk and/or extremities [including hands and feet] …) or 12011- 12018 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes …), established on what are the size and location of the wound.
Measuring tip: For excision of skin lesions, measure the lengthiest dimension of an oblong mass.

Intermediate Repair
Once you find the term "intermediate repair," it implies that your dermatologist performed any of two things: Layered closure of either one or more than one deeper layers (subcutaneous and superficial fascia/ non-muscle) also to skin; or Single-layer closure of severely contaminated wounds needing extensive cleaning.
Discover your intermediate repair codes at 12031-12037 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet …); 12041-12047 (Repair, intermediate, wounds of neck, hands, feet and/or external genitalia …); and 12051-12057 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes …).
Cleaning must be above and beyond: Every closure needs some cleaning that won't essentially validate an intermediate code. In case you categorize a procedure as intermediate owing to the contamination level and cleaning, ensure that you have sufficient documentation to support it. Payers will require notes about how extensive the wound was, the amount of work that the cleaning required, and how much time was spent on the procedure.
Examine Complex Repair Choices
Complex repair involves layered closure, but you should consider more than layers to justify using these codes. Your dermatologist's documentation should include notes about fixing a defect, executing extensive tissue debridement, or even forming a defect to repair a problem.
Want to get more tips like these to master dermatology billing and coding? Click here to read the entire article and to get access to our monthly Dermatology Coding Alert: Your practical adviser for ethically optimizing dermatology billing and coding, payment, and efficiency for dermatology practices
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