2 Code Claims Complex Closures on Excision Claims

When closures become complicated, it is possible to have a two code claim. If the ED physician removes a lesion, he or she will also need to close the site prior to releasing the patient to go home. If the closure is a simple repair, then the work is combined into the lesion excision code. If the repair is more complicated then that though, then you can report the closure separately.

If an intermediate closure is performed by the ED physician, then you will choose a code from the 12031 – 12057 set, but for complex closures, then you will choose a code from the 13100 – 13153 set.

These types of complex or intermediate repairs are quite common in the ED. For example, say the physician removes a cyst. The physician might use subcutaneous sutures at the site so that the wound won’t fill with fluid.

Let’s do an example claim. If the ED physician excises a benign lesion from the patient’s arm, and the total excision area is 4.4 cm, the physician has to perform a 4.0 cm intermediate wound closure.

The proper way to report this on the claim is as follows:

-Report 11406 for the lesion excision (this code is for excision of benign lesions, with a diameter of over 4.0 cm)
-Report 12032 for the closure of the excision site (this code is for closures 2.6 cm to 7.5 cm)
-Attach modifier 51 (which is multiple procedures) to the 12032 code in order to show that the closure and the excision required multiple procedures.

View all Articles by: Kathryn E, CCS-P - Retired