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Mar 27th, 2018 - sharris

Undermining - Simple - Intermediate - Complex

Patient had lesion removed, the specimen was sharply excised at the level of the subcutaneous fat. The skin margins were undermined and the wound was then closed in a layered fashion with 4-0 biosyn followed by a running subcuticular 4-0 byosyn for superficial skin closure.

Provider wants to bill complex repair for closure. I feel simple lesion removal only as " at the level" you are not in subcu. He thinks undermining regardless is complex.

I would like to get an opinion as this is an ongoing struggle.

Thank You.

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Mar 27th, 2018 - Ortho 1 

re: Undermining - Simple - Intermediate - Complex

There are three requirements met with the information provided to justify reporting a complex closure, the undermining is not the only justification for coding a complex closure in this scenario.

• The Level, subcutaneous fat
• Layered closure
• Undermining

This is assuming there is nothing else documented according to the following AMA Guideline:

“Complex repair includes the repair of wounds requiring more than layered closure, viz., scar revision, debridement (eg, traumatic lacerations or avulsions), extensive undermining, stents or 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."

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