How To Use CPT Code 12031

CPT 12031 is used for intermediate repair of wounds on specific body areas, measuring 2.5 cm or less. This article covers the description, procedure, qualifying circumstances, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 12031.

1. What is CPT 12031?

CPT 12031 is a medical billing code used to describe the intermediate repair of wounds on the scalp, axillae, trunk, and/or extremities (excluding hands and feet) that are 2.5 cm or less in size. Intermediate repair involves the closure of wounds that require layered suturing of one or more of the deeper layers of subcutaneous tissue and superficial fascia, in addition to the skin closure.

2. 12031 CPT code description

The official description of CPT code 12031 is: “Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less.”

3. Procedure

1. Obtain informed consent from the patient.
2. Bring the patient to the operating room and prepare the operative site using sterile draping.
3. Administer local anesthesia to the patient.
4. Inspect the wound and irrigate it with normal saline.
5. Perform proper debridement of the wound, removing any damaged or contaminated tissue.
6. Bring the wound edges together to form a linear closure.
7. Suture the inner layer of the skin (subcutaneous, dermis, and/or superficial fascia) using absorbable sutures.
8. Close the external layer of the skin using sutures or staples in a linear fashion.
9. Apply Dermabond or a similar adhesive to the wound, if necessary.

4. Qualifying circumstances

Patients eligible to receive CPT 12031 services are those with wounds on the scalp, axillae, trunk, and/or extremities (excluding hands and feet) that require intermediate repair. The wound size must be 2.5 cm or less. Intermediate repair is necessary when the wound involves deeper layers of subcutaneous tissue and superficial fascia, requiring layered closure. Additionally, heavily contaminated wounds that require extensive cleaning or removal of particulate matter may also qualify for CPT 12031, even if a single-layer closure is performed.

5. When to use CPT code 12031

It is appropriate to bill CPT 12031 when a healthcare provider performs an intermediate repair of a wound on the scalp, axillae, trunk, and/or extremities (excluding hands and feet) that is 2.5 cm or less in size. The code should be used when the wound requires layered closure of one or more of the deeper layers of subcutaneous tissue and superficial fascia, in addition to the skin closure. It can also be used for heavily contaminated wounds that require extensive cleaning or removal of particulate matter, even if a single-layer closure is performed.

6. Documentation requirements

To support a claim for CPT 12031, the following information should be documented in the patient’s medical record:

• Location and size of the wound
• Type of repair performed (intermediate)
• Specific layers of tissue involved in the repair
• Debridement and cleaning of the wound, if applicable
• Type of sutures or staples used for closure
• Use of adhesive, if applicable
• Any complications or additional procedures performed during the repair

7. Billing guidelines

When billing for CPT 12031, it is important to follow the appropriate guidelines and rules. Ensure that the wound location and size, as well as the type of repair, are accurately documented in the patient’s medical record. If multiple repairs are performed, combine them based on repair class (simple or intermediate) and anatomic site. Use modifier 51 to report dissimilar lacerations, listing the more complicated repair as the primary procedure and the less complicated repair as the secondary procedure.

8. Historical information

CPT 12031 was added to the Current Procedural Terminology system on January 1, 1990. The code descriptor was changed on January 1, 2009, from “Layer closure of wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less” to its current description.

9. Similar codes to CPT 12031

Five similar codes to CPT 12031 and how they differ are:

1. CPT 12001: Simple repair of wounds on the same body areas, measuring 2.5 cm or less.
2. CPT 12002: Simple repair of wounds on the same body areas, measuring 2.6 cm to 7.5 cm.
3. CPT 12011: Simple repair of superficial wounds on the face, ears, eyelids, nose, lips, and/or mucous membranes, measuring 2.5 cm or less.
4. CPT 12032: Intermediate repair of wounds on the same body areas, measuring 2.6 cm to 7.5 cm.
5. CPT 12034: Intermediate repair of wounds on the same body areas, measuring 7.6 cm to 12.5 cm.

10. Examples

Here are 10 detailed examples of CPT code 12031 procedures:

1. A patient with a 2 cm laceration on the scalp that requires layered closure.
2. A 1.5 cm wound on the trunk that involves the deeper layers of subcutaneous tissue and superficial fascia.
3. A 2.5 cm laceration on the forearm that requires extensive cleaning and removal of particulate matter before closure.
4. A patient with a 2 cm wound on the axilla that requires suturing of both the dermis and subcutaneous layers.
5. A 1.8 cm laceration on the thigh that involves the deeper layers of subcutaneous tissue and requires layered closure.
6. A 2.3 cm wound on the upper arm that requires debridement and suturing of the dermis and subcutaneous layers.
7. A patient with a 1.2 cm laceration on the lower leg that requires extensive cleaning and layered closure.
8. A 2.5 cm wound on the calf that involves the deeper layers of subcutaneous tissue and superficial fascia, requiring layered closure.
9. A 1.7 cm laceration on the back that requires suturing of both the dermis and subcutaneous layers.
10. A 2.1 cm wound on the upper chest that requires debridement and suturing of the dermis and subcutaneous layers.