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A complex repair of a wound involving the eyelids, nose, ears, and/or lips is a surgical procedure that addresses significant injuries or defects in these delicate areas. This type of repair is necessary when a wound cannot be closed simply with layered closure techniques due to its complexity. The procedure begins with the cleansing of the wound and the administration of a local anesthetic to ensure patient comfort. Following this, the wound is thoroughly inspected to assess its condition and determine the appropriate repair method. In cases where the procedure is aimed at scar revision, the existing scar tissue is excised to facilitate a more aesthetically pleasing outcome. For traumatic injuries such as lacerations or avulsions, the wound is meticulously cleaned, and any foreign materials are removed. Debridement may be performed using sharp dissection techniques to remove devitalized tissue, and extensive undermining of the surrounding tissues is often necessary to reduce tension during closure. Control of bleeding is critical and can be achieved through chemical means or electrocautery. The closure technique varies based on the wound's location and nature; deeper layers may be secured with absorbable sutures, while non-absorbable sutures are typically used for the superficial layers. In some cases, retention sutures may be employed to hold the wound edges together without exerting tension, utilizing a short length of plastic or rubber tubing threaded over each suture. Additionally, stents may be applied to maintain tissue position or keep an orifice open. Throughout the procedure, careful attention is given to align the wound edges properly to minimize the risk of scar depression. This code, 13151, specifically applies to complex repairs of wounds measuring between 1.1 cm and 2.5 cm in length, while 13152 is designated for wounds ranging from 2.6 cm to 7.5 cm. For wounds exceeding 7.5 cm, the add-on code 13153 should be utilized for each additional 5 cm or less.
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The complex repair of wounds involving the eyelids, nose, ears, and/or lips is indicated for various conditions that necessitate a more intricate surgical approach. These indications include:
The procedure for a complex repair of a wound of the eyelids, nose, ears, and/or lips involves several critical steps to ensure effective healing and optimal cosmetic results. The first step is the thorough cleansing of the wound to remove any debris or contaminants, followed by the administration of a local anesthetic to minimize discomfort during the procedure. Once the area is adequately anesthetized, the surgeon inspects the wound to assess its complexity and determine the appropriate repair method. If the procedure is for scar revision, the surgeon will excise the existing scar tissue to create a fresh wound edge that can be more easily closed. In cases of traumatic lacerations or avulsions, the wound is carefully cleaned, and any particulate matter is removed to prepare the site for repair. Debridement may be performed using sharp dissection techniques to eliminate any non-viable tissue, ensuring a healthy environment for healing. Extensive undermining of the surrounding tissues is often necessary to reduce tension on the wound edges during closure. This is achieved using scissors or a scalpel to create a more favorable tension-free closure. Control of bleeding is paramount and can be managed through chemical agents or electrocautery to ensure hemostasis. The closure of the wound is tailored to its specific characteristics; the deepest layers may be closed with absorbable sutures, which are designed to dissolve over time, while the superficial layers are typically secured with non-absorbable sutures for durability. In some instances, retention sutures may be utilized to hold the edges of the wound together without tension, which involves placing sutures through the entire thickness of the wound and threading a short length of plastic or rubber tubing over each suture before tying them. Additionally, stents may be employed to maintain tissue position or keep an orifice open during the healing process. Throughout the procedure, meticulous care is taken to align the wound edges properly to prevent complications such as scar depression.
After the complex repair procedure, post-operative care is essential for optimal recovery and healing. Patients are typically monitored for any signs of complications, such as infection or excessive bleeding. Instructions for wound care will be provided, which may include keeping the area clean and dry, applying prescribed topical medications, and avoiding activities that could stress the repair site. Patients may also be advised on pain management strategies, including the use of over-the-counter pain relievers or prescribed medications. Follow-up appointments are crucial to assess the healing process, remove sutures if necessary, and evaluate the cosmetic outcome of the repair. It is important for patients to adhere to all post-operative instructions to ensure proper healing and minimize the risk of complications.
| Short Descr | CMPLX RPR E/N/E/L 1.1-2.5 CM | Medium Descr | REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM | Long Descr | Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm | Status Code | Active Code | Global Days | 010 - Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6A - Minor procedures - skin | MUE | 1 | CCS Clinical Classification | 19 - Other therapeutic procedures on eyelids, conjunctiva, cornea |
This is a primary code that can be used with these additional add-on codes.
| 20701 | Add-on Code MPFS Status: Active Code APC N Removal of drug-delivery device(s), deep (eg, subfascial) (List separately in addition to code for primary procedure) |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | GC | This service has been performed in part by a resident under the direction of a teaching physician | SG | Ambulatory surgical center (asc) facility service | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 54 | Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | E1 | Upper left, eyelid | E2 | Lower left, eyelid | E3 | Upper right, eyelid | E4 | Lower right, eyelid | GA | Waiver of liability statement issued as required by payer policy, individual case | GJ | "opt out" physician or practitioner emergency or urgent service | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | LT | Left side (used to identify procedures performed on the left side of the body) | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | PT | Colorectal cancer screening test; converted to diagnostic test or other procedure | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) | SA | Nurse practitioner rendering service in collaboration with a physician | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter |
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| 2013-01-01 | Changed | Short Descriptor changed. |
| Pre-1990 | Added | Code added. |
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