A diabetic patient undergoes a transmetatarsal amputation. Due to the infectious process, the surgeon decides to perform delayed closure at point “X” in the future. When the time arrives to close the surgical site, the appropriate wound closure code is billed appended by the 58 modifier. This confirms a documented “staged, related, pre-planned procedure.”
CPT code 13160 is defined as the following: Secondary closure of surgical wound or dehiscence, extensive or complicated.
• Is this really what is being performed?
• Delayed primary closure is based upon whether the repair is intermediate or complex
Intermediate vs. Complex Repair
• Intermediate Repair: CPT codes 12041 - 12047
Includes the repair of 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 that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair.
• Complex repair: CPT code 13160
Includes the repair of wounds requiring more than layered closure 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 (eg, 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, stents vermilion border, or nostril rim
-placement of Retention sutures.
Necessary preparation includes creation of a limited defect for repairs or the debridement of complicated lacerations or avulsions.
Complex repair does not include excision of benign (11400-11446) or malignant (11600-
11646) lesions, excisional preparation of a wound bed (15002-15005) or debridement of an open fracture or open dislocation.
This is my opinion.
Michael G. Warshaw
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