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A complex repair of a wound involving the eyelids, nose, ears, and/or lips is a specialized surgical procedure that addresses significant injuries or defects in these delicate areas. This type of repair is necessary when a wound cannot be closed using simple techniques and requires more intricate methods to ensure proper healing and aesthetic outcomes. The procedure begins with the cleansing of the wound to remove any debris or contaminants, followed by the administration of a local anesthetic to minimize discomfort during the repair. Upon inspection, if the wound is determined to necessitate more than a layered closure, the surgeon may proceed with complex techniques. In cases where the repair is aimed at scar revision, the existing scar tissue may be excised to facilitate a more favorable cosmetic result. For traumatic injuries such as lacerations or avulsions, thorough cleansing and removal of particulate matter are critical steps. The surgeon may also perform debridement using sharp dissection to prepare the wound for closure. To reduce tension on the wound edges, extensive undermining of the surrounding tissues may be performed. Hemostasis is achieved through chemical means or electrocautery to control any bleeding. The closure technique varies based on the wound's location and nature; deeper layers may be secured with absorbable sutures, while superficial layers are typically closed with non-absorbable sutures. In some cases, retention sutures may be employed to hold the wound edges together without tension, utilizing a short length of tubing to facilitate this process. Additionally, stents may be used to maintain tissue alignment or keep an orifice open during healing. Careful alignment of the wound edges is essential to prevent complications such as scar depression, ensuring both functional and aesthetic restoration. For coding purposes, the appropriate CPT® codes must be utilized based on the length of the wound, with specific codes designated for primary and additional repairs.
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The complex repair of wounds involving the eyelids, nose, ears, and/or lips is indicated for various conditions that necessitate advanced surgical intervention. These indications include:
The procedure for a complex repair of wounds in the specified areas involves several detailed steps:
Post-procedure care is crucial for optimal healing and may include instructions for wound care, signs of infection to monitor, and follow-up appointments for suture removal or assessment of healing. Patients are typically advised to keep the area clean and dry, avoid strenuous activities that could stress the repair, and follow any specific guidelines provided by the surgeon. The expected recovery time may vary based on the complexity of the repair and the individual patient's healing response. Regular follow-up visits are important to ensure proper healing and to address any concerns that may arise during the recovery process.
| Short Descr | CMPLX RPR E/N/E/L ADDL 5CM/< | Medium Descr | REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/< | Long Descr | Repair, complex, eyelids, nose, ears and/or lips; each additional 5 cm or less (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No 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 | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6B - Minor procedures - musculoskeletal | MUE | 2 | CCS Clinical Classification | 19 - Other therapeutic procedures on eyelids, conjunctiva, cornea |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 13152 | MPFS Status: Active Code APC T ASC A2 CPT Assistant Article Illustration for Code Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm | 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). | 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. | 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. | 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. | 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.) | 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.) | CR | Catastrophe/disaster related | E3 | Upper right, eyelid | ET | Emergency services | GC | This service has been performed in part by a resident under the direction of a teaching physician | GJ | "opt out" physician or practitioner emergency or urgent service | 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) | 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) | SG | Ambulatory surgical center (asc) facility service | X2 | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2013-01-01 | Changed | Short Descriptor changed. |
| 2000-01-01 | Added | First appearance in code book in 2000. |
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