Differentiate Wound Repair Versus Tissue Transfer To Achieve Proper Coding
When your surgeon carries out a wound repair closure
, you could be miscoding if you turn to 12001-13160 automatically. You need to dig deep into the surgeon's documentation to see if the tissue transfer code is more apt. However knowing the difference between wound repairs and tissue transfers is only the start. See to it that your surgeon gets the reimbursement he deserves:
Know the difference between transfers and repairs
For wound closure procedures, you will first need to decide between wound repair codes 12001-13160 and adjacent tissue transfer codes 14000-14300.
Determine overall area and location
According to CPT instructions, once you determine that your surgeon carried out a tissue transfer, you will need to narrow down your code selection by determining the total area of the primary and secondary defects.
After adding up the affected area, look at the repair's anatomical location to narrow your choices further.
Skip separate lesion removal coding
You shouldn't separately report any lesion removals your surgeon carries out during a tissue transfer procedure. The excision of the benigh lesion or of the malignant lesion is not separately reported with the tissue codes. This guidance is reinforced by both CPT and CMS/CCI guidelines.
Exception: If your surgeon carries out an excision on a separate day from the tissue transfer, you may go on to report the procedures separately. You might stand witness to this scenario if your surgeon is waiting for the pathology report to be sure the lesion margins are clear prior to closing the operative wound. If the tissue transfer takes place during the excision's 10-day global period, go for modifier 58 to the tissue transfer code.