Summary & Overview
CPT 13102: Complex Wound Repair, Trunk, Each Additional 5 cm or Less
CPT code 13102 is a critical billing code for complex wound repair procedures on the trunk, specifically for each additional 5 cm or less beyond the primary repair. This code is widely recognized across major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, underscoring its importance in surgical billing and reimbursement.
The publication provides a comprehensive overview of 13102, detailing its clinical context, typical use in outpatient hospital settings, and its role in surgical specialties such as general surgery, plastic surgery, and surgical oncology. Readers will gain insight into the procedural benchmarks, relevant policy updates, and the clinical scenarios where this code is applied, including lacerations, surgical wound disruptions, and scar conditions. The summary also highlights common modifiers used in conjunction with 13102, such as 51 for multiple procedures and 59 for distinct procedural services, as well as associated taxonomies and ICD-10 diagnoses relevant to complex trunk repairs.
This article serves as a resource for understanding the national landscape of complex wound repair coding, offering clarity on payer coverage, clinical indications, and related procedural codes. It is designed for healthcare professionals, billing specialists, and policy analysts seeking up-to-date information on surgical coding practices and reimbursement trends.
CPT Code Overview
CPT code 13102 describes the repair of complex wounds on the trunk, specifically for each additional 5 cm or less, and is listed separately in addition to the code for the primary procedure. This code is used in surgical settings where advanced techniques are required to address challenging lacerations, surgical wounds, or scar conditions. The typical site of service for this procedure is an outpatient hospital (Place of Service 22), reflecting its use in ambulatory surgical environments. As a surgical service, 13102 is commonly performed by physicians specializing in surgery, plastic surgery, or surgical oncology.
Clinical & Coding Specifications
Clinical Context
A patient presents to the outpatient hospital with a complex laceration on the trunk, such as the abdominal wall or shoulder, following trauma or surgery. The wound requires meticulous layered closure due to its complexity, which may involve scar tissue or disruption of a previous surgical site. The primary repair is performed, and the total length of the wound exceeds the initial measurement covered by the primary CPT code. For each additional 5 cm or less of complex repair beyond the primary segment, CPT code 13102 is reported as an add-on. The clinical workflow involves assessment, anesthesia, layered closure, and documentation of wound measurements to ensure accurate coding.
Coding Specifications
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Modifier
51(Multiple Procedures): Used when multiple surgical procedures are performed during the same session. Indicates that more than one procedure was done, and may affect payment. -
Modifier
59(Distinct Procedural Service): Used to indicate that a procedure or service is distinct or independent from other services performed on the same day. Applied when procedures are not normally reported together but are appropriate due to clinical circumstances.
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