The physician/QHP should document a procedure note that includes the following when applicable:

• Size of the wound in centimeters (regardless of shape) after closure.
• Anatomical wound location (e.g., face, trunk, hand).
• Depth of wound or layers of tissue closed.
• Extent of undermining or debridement when required.
• Extensive cleaning of contamination when required.
• Notation of exposed bone, cartilage, tendon, and neurovascular structure.

Additional clinically relevant details such as hemostasis, local or topical anesthesia, simple ligation of vessels in the wound and simple “exploration” of nerves, blood vessels or tendons exposed may also be documented, but these are all considered part of the essential treatment of any wound and do not affect code selection and are not separately reported.

According to CPT guidelines, laceration repair codes should be reported when a physician/QHP performs a wound closure using sutures, staples, or tissue adhesives alone, in combination with each other, or with adhesive strips. The repair of wounds are classified as Simple, Intermediate, or Complex.

• Simple (CPT codes 12001-12021)
• Intermediate (CPT codes 12031-12057)
• Complex (CPT codes 13100-13160)

The CPT manual classifies laceration repair codes according to 3 components: the length of the laceration (in centimeters), the complexity of the repair (e.g., single or multilayered), and the anatomic location of the laceration. CPT manual example components and cutoffs listed below:

Length of laceration (cm)

• Specific CPT codes depicting wound length are dependent on the location and complexity
• In general, CPT defines the length cutoffs at 2.6cm, 5.1cm, 7.6cm, 12.6cm, 20.1cm, and 30cm
• For example, a simple wound repair to the scalp, neck, axillae, external genitalia, trunk, and/or extremities (including hands and feet) would use the following codes based on the size of the wound:
  • 12001: ≤ 2.5cm
  • 12002: 2.6-7.5cm
  • 12004: 7.6cm-12.5cm
  • 12005: 12.6cm-20.0cm
  • 12006: 20.1cm-30.0cm
  • 12007: >30cm

Complexity of repair

• Components that determine complexity include number of layers repaired, undermining required, contamination requiring extensive cleaning or debridement, exposure of deeper structures (bone, tendon, neurovasculature)
• Examples of classification based on layering:
  • Simple - Single Layer
  • Intermediate – Multilayered or heavily contaminated single layer requiring extensive cleaning

Anatomic Location

• The location of the wound informs a different CPT code even when the length and complexity may otherwise be the same. For example:
  • 12004: 12cm simple scalp laceration
  • 12015: 12cm simple facial laceration

A simple wound repair code is used when the wound is superficial, primarily involving the epidermis, dermis, or subcutaneous tissues without significant involvement of deeper structures where only one layer of closure with sutures, staples, or tissue adhesive. Simple lacerations are defined by two anatomic location groupings, as below:

• 12001-12007: simple repair to scalp, neck, axilla, external genitalia, trunk, and/or extremities (including hands and feet)
• 12011-12018: simple repair to face, ears, eyelids, nose, lips, and/or mucous membranes

An intermediate wound repair code would be used for wounds that require 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. It includes limited undermining (defined as a distance less than the maximum width of the defect, measured perpendicular to the closure line, along at least one entire edge of the defect). Single-layer closure of heavily contaminated wounds requiring extensive cleaning or removal of particulate matter also constitutes intermediate repair.

For intermediate (layered) wound repairs that require extensive debridement, the debridement code would be identified in addition to the repair.

Intermediate lacerations are defined by three anatomic location groupings as below:

• 12031-12037: intermediate repair to scalp, axilla, trunk, and/or extremities (excluding hands and feet)
• 12041-12047: intermediate repair to neck, hands, feet and/or external genitalia
• 12051-12057: intermediate repair to face, ears, eyelids, nose, lips, and/or mucous membranes

A complex wound repair code would be used for repairs that, in addition to the requirements for intermediate repair, require at least one of the following: exposure of bone, cartilage, tendon, or named neurovascular structure; debridement of wound edges (e.g., traumatic lacerations or avulsions); extensive undermining (defined as a distance greater than or equal to the maximum width of the defect, measured perpendicular to the closure line along at least one entire edge of the defect); involvement of free margins of helical rim, vermilion border, or nostril rim; placement of retention sutures. Necessary preparation includes the creation of a limited defect for repairs or the debridement of complicated lacerations or avulsions.

Complex lacerations are defined by four anatomic location groupings as below:

• 13100-13102: complex repair to the trunk
• 13120-13122: complex repair to scalp, arms, and/or legs
• 13131-13133: complex repair to forehead, cheeks, chin, mouth, neck, axilla, genitalia, hands, and/or feet
• 13151-13153: complex repair to eyelids, nose, ears, and/or lips

Limited undermining is less than the maximum width of the wound, measured perpendicular to the closure line, along at least one entire edge of the wound.

Extensive undermining is defined as a distance greater than or equal to the maximum width of the wound, measured perpendicular to the closure line along at least one entire edge of the wound.

The coding for the application of tissue adhesives like Dermabond varies according to the insurance provider. For non-Medicare patients, lacerations repaired with tissue adhesives will be coded with the standard wound repair codes depending on the complexity of the wound: simple (12001-12021), intermediate (12031-12057), or complex (13100-13153).

For Medicare beneficiaries, HCPCS code G0168 should be reported for a wound that is repaired only using tissue adhesive.  However, if tissue adhesives are used in conjunction with other closure methods, e.g., sutures or staples, the repair should be coded with the regular CPT codes for wound repair.

No. Surgicel is a hemostatic agent used to control bleeding and aligns more closely with cauterization, thus should not be separately reported and would be included in the appropriate E/M code.

No. Repair of a superficial wound with adhesive strips, chemical cauterization or electrocauterization, as the sole repair (i.e., no sutures or tissue adhesives) would be included as part of the E/M code for the ED visit. It should not be billed as a separate procedure.

Yes. When multiple wounds are repaired, the lengths of all wounds that share the same complexity and anatomical location should be summed to determine the appropriate code. The documentation should identify each individual wound repaired, including the length and complexity of the repair.  For coding purposes, the total lengths of wounds should be calculated based on their classification (e.g., intermediate) and anatomical grouping as stated in the code descriptor (e.g., scalp, axilla, trunk, or extremity) and reported with the appropriate CPT code. 

For example, suppose a patient had two lacerations, one on the forearm (1.5cm) and one on the trunk (3.0cm), both requiring simple repair. The correct CPT code would be determined by adding the lengths together to report a 4.5cm simple repair using CPT code 12002 (Simple repair scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6cm-7.cm wound.)

If multiple wounds share the same anatomical location but differ in complexity, they are reported separately, with the more complex repair being listed first.  For instance, a patient arrives with two lacerations on the left forearm; one measures 1.5cm and necessitates a simple repair, while the other, at 3.0cm, requires a layered closure. The intermediate repair of the 3.0cm laceration would be coded as CPT 12032. The 1.5cm repair would be listed with the code 12001, and modifier -51 would be attached to indicate that it is a secondary procedure performed during the same session: 12001-51.

When coding for multiple wounds from different anatomical groups as described by the code descriptors, each wound should be coded individually. The more complex wound repair is listed first. For example, a patient presents with a simple 2.5 cm laceration on the scalp and a 5 cm intermediate laceration on the lower leg.  The correct coding would be 12032 for the intermediate repair on the extremity, followed by 12001 for the simple repair on the scalp. To indicate that these procedures may not typically be reported together but are permissible in this situation, a -59 modifier should be appended to the second procedure code to indicate a distinct procedure, different anatomical site or organ system, or different injury area.

CPT instructs when a wound is left to heal by secondary intention, debridement codes should be reported. Debridement is a distinct procedure, separate from routine wound cleansing, and is only considered a separate procedure when specific criteria are met, such as:

• gross contamination requires prolonged cleansing,
• when appreciable amounts of devitalized or contaminated tissue are removed, or
• when debridement is carried out separately without immediate primary closure.

Wound debridement coding should reflect the debridement type, tissue depth, and wound area. CPT 97597 and 11042-11047 apply to different scenarios.

• CPT 97597 is reported for debridement (e.g., high-pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less
• CPT 11042-11047 describes debridement reaching subcutaneous tissue, muscle/fascia, or bone, and may include excising viable tissue for a better wound margin. These are session-based and require documentation of depth and area.

Differences:

• Depth: 97597 for superficial debridement of dermal/epidermal layers vs. 11042-11047 for deeper tissue layers.
• Wound Type: 97597 for selective debridement vs. 11042-11047 for selective/non-selective.
• Extent: 97597 for first 20 sq cm vs. 11042-11047 for any size, with specific codes for depth and additional surface area.

In the emergency department, debridement may be necessary to treat superficial wounds that are heavily contaminated, require extensive cleaning, or have significant devitalized or contaminated tissue that must be removed. According to CPT Assistant (August 2016), if the tissue removed is at the subcutaneous tissue level or deeper, it would be appropriate to report codes 11042-11047. However, if the debridement is limited to the epidermis or dermis levels only, codes 97597-97598 should be used.

Of note, anesthesia/local infiltration, including peripheral nerve blocks used as part of the debridement procedure, are NOT separately billable.

For Medicare, suture removal for simple laceration repair is not bundled into procedure codes 12001-12018. Follow-up visits and suture removal charges may be assigned as appropriate.

For payers adhering to CPT coding principles, suture removal is included in the surgical package as typical uncomplicated post-op care.

See the ACEP Surgical Package FAQ for coding guidance regarding subsequent visits and suture removals for laceration repairs.