Summary & Overview
CPT 12017: Simple Repair of Superficial Facial Wounds, 20.1–30.0 cm
CPT code 12017 is a nationally recognized billing code for the simple repair of superficial wounds of the face, ears, eyelids, nose, lips, and mucous membranes, specifically for wound lengths between 20.1 cm and 30.0 cm. This surgical procedure is commonly performed in office settings and is relevant for a wide range of clinical specialties, including surgery, family medicine, and dermatology. The code is essential for accurate billing and reimbursement, as it distinguishes between different wound lengths and repair complexities.
Major payers covering this code include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides an overview of payer coverage, clinical context, and related coding benchmarks. Readers will gain insights into policy updates, coding practices, and the clinical scenarios in which CPT 12017 is utilized. The summary also highlights associated modifiers and taxonomies, as well as related CPT codes for different wound lengths. This information is valuable for understanding national trends in wound repair billing and ensuring compliance with payer requirements.
CPT Code Overview
CPT 12017 describes the simple repair of superficial wounds measuring 20.1 cm to 30.0 cm on the face, ears, eyelids, nose, lips, and/or mucous membranes. This procedure is classified as a surgical service and is typically performed in an office setting (Place of Service 11). The code is used when wounds require closure but do not involve deeper structures or complex repair techniques. Accurate coding ensures proper documentation and reimbursement for these common wound repairs in outpatient clinical practice.
Clinical & Coding Specifications
Clinical Context
A patient presents to the office with multiple superficial lacerations to the face, ears, eyelids, nose, lips, or mucous membranes. The total length of the wounds requiring repair is between 20.1 cm and 30.0 cm. The provider performs a simple repair, which involves cleaning the wounds, ensuring there is no foreign body, and closing the wounds with sutures or other appropriate materials. The procedure is performed in an office setting, and the patient is typically seen by a provider specializing in surgery, family medicine, or dermatology. Documentation includes the location, length, and type of wounds, as well as the technique used for repair.
Coding Specifications
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Modifier
59: Used to indicate a distinct procedural service, such as when multiple repairs are performed at different anatomical sites or during separate encounters. -
Modifier
51: Used when multiple procedures are performed during the same session, allowing for proper sequencing and reimbursement.
| Modifier Code | Description |
|---|---|
59 | Distinct Procedural Service |