Brief overview of laceration repair coding.
Laceration repair is a commonly performed procedure by emergency department physicians and primary care physicians, involving the closure of wounds or cuts in the skin.
There are 3 types of repair:
Simple Repair (12001 to 12018)
Simple repair is used when the wound is superficial (involving primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures) and requires simple one layer closure.
The simple repair codes include all local anesthesia and chemical or electrocauterization of wounds not closed. The codes are further classified by the anatomical location and length of the repair.
Scalp, Neck, Axillae, External Genitalia, Trunk, Extremities (including Hands and Feet):
12001: 2.5 cm or less
12002: 2.6 cm to 7.5 cm
12004: 7.6 cm to 12.5 cm
12005: 12.6 cm to 20.0 cm
12006: 20.1 cm to 30.0 cm
12007: Over 30.0 cm
Face, Ears, Eyelids, Nose, Lips, Mucous Membranes:
12011: 2.5 cm or less
12013: 2.6 cm to 5.0 cm
12014: 5.1 cm to 7.5 cm
12015: 7.6 cm to 12.5 cm
12016: 12.6 cm to 20.0 cm
12017: 20.1 cm to 30.0 cm
12018: Over 30.0 cm
Intermediate (e.g., CPT codes 12031-12057)
one layered closure of one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia in addition to the skin (epidermal and dermal) closure.” In other words, wounds requiring intermediate repairs are deeper than those requiring simple repair.
or
where a single layer needs extensive cleaning. When searching documentation for clues as to the complexity of repair, statements such as “layered closure,” “involving subcutaneous tissue,” and/or “removal of debris,” “extensive cleansing,” etc., point to an intermediate repair. Lack of these details, or a statement of “single layer closure,” suggests a simple repair.
Synonyms:
Layered Closure
Intermediate repair
Simple repair + Removal of particulate matter or foreign body
Simple repair + Extensive cleaning
Complex (e.g., CPT codes 13100-13160):
Meant for repairing more severe wounds, with additional requirements beyond those for intermediate repair.
Requirements:
May involve exposure of underlying structures such as bone, tendon, or named neurovascular structures.
Could require debridement (cleaning out) of wound edges, especially for traumatic lacerations or avulsions (tissue tears).
Often includes extensive undermining, where the area of separation of the wound edges is greater than the maximum width of the defect, measured at right angles to the closure line.
Involves the free margins of delicate areas like the helical rim (outer ear), vermilion border (lip edge), or nostril rim.
Trunk:
13100: 1.1 cm to 2.5 cm
13101: 2.6 cm to 7.5 cm
13102: Each additional 5 cm or less (List separately in addition to code for primary procedure)
Scalp, Arms, and/or Legs:
13120: 1.1 cm to 2.5 cm
13121: 2.6 cm to 7.5 cm
13122: Each additional 5 cm or less (List separately in addition to code for primary procedure)
Forehead, Cheeks, Chin, Mouth, Neck, Axillae, Genitalia, Hands, and/or Feet:
13131: 1.1 cm to 2.5 cm
13132: 2.6 cm to 7.5 cm
13133: Each additional 5 cm or less (List separately in addition to code for primary procedure)
Eyelids, Nose, Ears, and/or Lips:
13151: 1.1 cm to 2.5 cm
13152: 2.6 cm to 7.5 cm
13153: Each additional 5 cm or less (List separately in addition to code for primary procedure)
Scenarios and Case Studies
Scenario 1: Simple Facial Laceration Repair
Dr. Smith treats a patient with a superficial 4.5 cm laceration on the cheek. The wound only involves the epidermis and dermis and requires a single-layer closure.
Answer: For this simple repair of a facial wound, the appropriate CPT code is 12013, which is for "Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm."
Scenario 2: Intermediate Repair of a Leg Wound
A patient presents with a 15 cm laceration on the thigh. Dr. Lee performs a one-layered closure involving subcutaneous tissue and superficial fascia.
Answer: For this intermediate repair on the extremities (excluding hands and feet), the correct CPT code is 12035, which describes "Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 12.6 cm to 20.0 cm."
Scenario 3: Complex Repair of an Eyelid Laceration
Dr. Patel performs a complex repair on a patient with a 1 cm laceration on the eyelid that requires extensive undermining and suture placement for proper alignment.
Answer: This situation calls for CPT code 13150, "Repair, complex, eyelids, nose, ears, and/or lips; 1.0 cm or less," due to the complexity and location of the wound.
Scenario 4: Multiple Wound Repairs in One Session
A patient involved in a car accident has multiple wounds: a 9 cm simple laceration on the forearm, a 6 cm intermediate laceration on the back (trunk), and a 5 cm complex laceration on the forehead.
Answers: For the simple repair on the forearm, use 12002 "Simple repair of superficial wounds; 2.6 cm to 7.5 cm."
For the intermediate repair on the trunk, use 12031 "Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities; 2.5 cm or less" with an add-on code 12032 "Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities; 2.6 cm to 7.5 cm" because the total length is 6 cm which is between 2.6 cm to 7.5 cm.
For the complex repair on the forehead, use 13131 "Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm," which covers the length of 5 cm.
When combining the codes for billing: The complex repair code 13131 would be listed first as it is the most extensive procedure.
The intermediate repair code 12031 would be reported with modifier -59 to indicate it is a distinct procedural service.
The simple repair code 12002 would also be reported with modifier -59.
Final coding for billing: 13131, 12031-59 (plus 12032 for additional length), 12002-59
FAQs and Common Queries
How do I code for suture removal?
If a provider has placed sutures for a patient and the patient returns to the same provider for the suture removal within global period, then the visit for the suture removal cannot be charged, because the removal is included in the initial laceration repair code and EM visit is coded with 99024.
Laceration repair and Epistaxis
