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Dermatology Coding Alert

Reader Question:

Get Specific Notes for Complex Closure Claims

Question: Encounter notes specify only that the provider performed “extensive undermining” during a 4.6-cm trunk repair. Is this enough documentation to report a complex closure code?

Georgia Subscriber

Answer: That’s a tough question; extensive undermining certainly translates into at least an intermediate repair code. The documentation you provide isn’t enough to automatically cinch a complex repair code — though it might be possible.

Explanation: Many compliance departments do feel that “extensive undermining” is the key to separating intermediate and complex repair. So you might want to consider checking payer policy before choosing between one of the following codes for the service:

  • 13101 (Repair, complex, trunk; 2.6 cm to 7.5 cm) for a complex repair
  • 12032 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.6 cm to 7.5 cm) for an intermediate repair.

In an ideal situation, the note would read “complex repair with extensive undermining,” or similar words. So you might want to educate your providers on the proper types of notes necessary to make complex closure claims as clear as possible.

Why? If you undercode your complex repairs, it will take a mighty toll on your bottom line. Consider the above example; 13101 pays about $400 (11.21 nonfacility relative value units [RVUs] multiplied by the 2016 Medicare Physician Fee Schedule Conversion Rate of 35.8043). Conversely, 12031 pays about $307 (8.58 nonfacility RVUs multiplied by 35.804).