By Stacie Norris, MBA, CPC, CCS-P, Director of Coding Quality Assurance
Effective as of January 1, 2020, the introductory guidelines section of the Integumentary System Repair (Closure) section of CPT have been revised to further clarify the differences between Intermediate and Complex Wound Repairs. Prior to January 1, 2020, intermediate repairs were defined as either layered closure or single-layer closure of heavily contaminated wounds that required extensive cleaning or removal or particulate matter. Complex repairs were defined as layered closure plus scar revision, debridement, extensive undermining, or use of stents or retention sutures and preparation for the repair that could include creation of a limited defect or the debridement of complicated lacerations or avulsions. Parts of these definitions have been changed for 2020 wound repair coding, specifically the AMA clarified the differences between limited and extensive undermining.
The introductory guidelines in the CPT Integumentary System, Repair (Closure) subsection have been now been updated to provide more descriptive language to clarify that intermediate repair includes any limited undermining performed. The guidelines also explain that complex repair includes all the requirements listed for intermediate repair plus at least one of the following: exposure of bone, cartilage, tendon, or named neurovascular structure; debridement of wound edges; extensive undermining; involvement of free margins of the helical rim, vermillion border, or nostril rim; or placement of retention sutures. Note that references to stents and scar revision have been removed from the complex repair guidelines. The guidelines also now include definitions and an illustration of extensive undermining. Specific language is as follows:
“Intermediate repair includes LIMITED undermining defined as a distance LESS THAN the maximum width of the defect, measured perpendicular to the closure line.
Complex repair includes EXTENSIVE undermining defined as a distance EQUAL TO or GREATER THAN the maximum width of the defect, measured perpendicular to the closure line.”
With these revised more specific guidelines as to what constitutes limited and extensive undermining and what is required for complex repairs, it is very important that the ED providers that perform these repairs understand these differences so they can make certain they include these points in their wound repair documentation. As always, the documentation must support the code selection and providers should document their notes with as much specificity and detail in order to accurately support the services provided.