CPT 12031: Intermediate Repair of Small Scalp/Trunk/Extremity Wounds - OpenPayer

Summary & Overview

CPT 12031: Intermediate Repair of Small Scalp/Trunk/Extremity Wounds

Headline: CPT code 12031: Intermediate wound repair for small lacerations

Lead: CPT code 12031 covers the intermediate layered repair of wounds to the scalp, axillae, trunk, and extremities (excluding hands and feet) that are 2.5 cm or less, a common procedural entry in acute care and outpatient settings.

What this code represents and why it matters: CPT code 12031 identifies a mid-level surgical repair procedure used when a wound requires layered closure techniques rather than a simple superficial suture. Nationally, accurate use of this code affects clinical documentation, procedure tracking, and payment for a high-volume service in emergency departments, urgent care centers, and ambulatory surgical practices.

Key payers covered: The analysis includes major national payers: Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare.

Overview of reader takeaways: Readers will find a clear summary of the clinical context for CPT code 12031, typical service locations, and how it relates to nearby procedural codes for simple and complex closures. The publication provides benchmarks and policy-relevant notes used by billing and compliance teams to align coding with documentation, plus comparisons to related closure codes to assist in correct code selection. Data not available in the input for payer-specific reimbursement rates and utilization trends.

AetnaBlue Cross Blue ShieldCigna HealthUnited HealthcareMedicareCPT 12031wound repairintermediate closurelaceration managementemergency medicinesurgical proceduresambulatory caredocumentationprocedure coding

Billing Code Overview

CPT code 12031 describes the intermediate repair of wounds to the scalp, axillae, trunk, and/or extremities (excluding hands and feet) that measure 2.5 cm or less. This procedure involves layered closure techniques beyond simple superficial suturing, appropriate for wounds requiring more than a simple repair but less than complex closure.

Service type: Intermediate wound repair (layered closure) of scalp, axillae, trunk, or extremities.

Typical site of service: Emergency department, outpatient clinic, urgent care, or physician office where acute laceration management and procedural wound closure are performed.

Clinical & Coding Specifications

Clinical Context

A 28-year-old male presents to the emergency department after accidentally lacerating his right upper arm on broken glass. Examination reveals a 2.0 cm deep partial-thickness laceration to the lateral right upper arm without signs of foreign body, active arterial bleeding, or neurovascular compromise. The wound involves subcutaneous tissue requiring layered closure. The clinician selects 12031 for an intermediate repair of a wound ≤2.5 cm on the trunk or extremity (excluding hands and feet). Local anesthesia is administered, the wound is irrigated and debrided of devitalized tissue, layered closure of the deeper tissue is performed with absorbable sutures, and the skin is closed with nonabsorbable interrupted sutures. The procedure is performed in the ED procedure room and documented as an initial encounter for a laceration of the upper arm, consistent with diagnosis code S41.101A. Typical workflow elements include informed consent, wound irrigation, foreign body check, hemostasis, layered closure, wound dressing, discharge instructions, and follow-up for suture removal and wound reassessment. Payors commonly involved include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service on the same day

CPT 19357: Breast Tissue Expander Placement with Serial Expansion

13101

CPT 13101: Complex Repair of Trunk Wound (2.6–7.5 cm)

19361

CPT 19361: Breast Reconstruction with Latissimus Dorsi Flap, No Implant

13100

CPT 13100: Complex Repair of Trunk Wounds

cpt-19361-latissimus-dorsi-breast-reconstruction-flap

CPT 19361: Breast Reconstruction with Latissimus Dorsi Flap

cpt-19364-free-flap-breast-reconstruction

CPT 19364: Free Flap Breast Reconstruction

19357

CPT 19357: Tissue Expander Placement for Breast Reconstruction

cpt-13100-complex-repair-trunk-1-1-to-2-5-cm

CPT 13100: Complex Repair of Wound, Trunk (1.1–2.5 cm)

19364

CPT 19364: Breast Reconstruction with Free Flap

cpt-12034-intermediate-wound-repair-7-6-to-12-5-cm-scalp-trunk-extremities

CPT 12034: Intermediate Wound Repair, 7.6–12.5 cm Scalp/Trunk/Extremities

Showing 1–10 of 17

Taxonomy Code	Specialty	Notes
`208600000X`	Surgery Physician	General surgeons or surgical subspecialists who perform wound repairs in operative or clinic settings.
`207Q00000X`	Family Medicine Physician	Primary care physicians who manage and repair lacerations in office or urgent care settings.
`207P00000X`	Emergency Medicine Physician	Emergency physicians who perform wound evaluation and intermediate repairs in the ED.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S01.81XA`	Laceration without foreign body of other part of head, initial encounter	Head lacerations requiring intermediate closure when location is not scalp, hands, or feet; applicable if the laceration site is coded to this specific head location.
`S41.101A`	Laceration without foreign body of right upper arm, initial encounter	Directly corresponds to a right upper arm laceration appropriate for intermediate repair with `12031` when ≤2.5 cm.
`S51.801A`	Laceration without foreign body of right forearm, initial encounter	Forearm lacerations within the size and depth criteria for intermediate closure.
`S61.401A`	Laceration without foreign body of right hand, initial encounter	Hand lacerations are listed among provided diagnoses but note that `12031` excludes hands and feet; if the procedure is on the hand, a different code would apply.
`S71.101A`	Laceration without foreign body of right thigh, initial encounter	Thigh lacerations appropriate for intermediate repair when size ≤2.5 cm.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11400-11466`	Excision of benign lesions requiring more than simple closure	Codes in this range are used for lesion excision where defect closure may require more extensive techniques than a standard repair; may be considered when excision rather than primary repair is performed.
`13100-13153`	Complex repair codes	Used for complex closures involving extensive undermining, layered closure of deep structures, or scar revision; used when repair complexity exceeds the definition of intermediate closure represented by `12031`.

OpenPayer