How To Use CPT Code 12054

CPT code 12054 describes the intermediate repair of wounds to the face, ears, eyelids, nose, lips, and/or mucous membranes that are 7.6 to 12.5 cm in size. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 12054?

CPT code 12054 is used to describe the intermediate repair of wounds to the face, ears, eyelids, nose, lips, and/or mucous membranes that are 7.6 to 12.5 cm in size. This code is used when a healthcare professional performs a more complex repair of a larger wound in these specific areas.

2. Official Description

The official description of CPT code 12054 is: ‘Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes 7.6 cm to 12.5 cm.’

3. Procedure

The procedure for CPT code 12054 involves the intermediate repair of wounds to the face, ears, eyelids, nose, lips, and/or mucous membranes that are 7.6 to 12.5 cm in size. After informed consent, the patient is brought to the operating room. The operative site is prepped and draped in a sterile manner, and local anesthesia is administered. The wound is inspected and irrigated with normal saline. Proper debridement of the wound is performed, and attention is then given to the repair of the wound. The wound edges are brought together to form a linear closure. The inner layer of skin (subcutaneous, dermis, and/or superficial fascia) is sutured with absorbable suture, followed by suturing of the external layer in a linear fashion. Dermabond may be applied to the wound for additional closure.

4. Qualifying circumstances

CPT code 12054 is used for wounds that require an intermediate level of repair on the face, ears, eyelids, nose, lips, and/or mucous membranes. The size of the wound must be between 7.6 and 12.5 cm. This code is appropriate when the healthcare professional performs a more complex repair of a larger wound in these specific areas.

5. When to use CPT code 12054

CPT code 12054 should be used when a healthcare professional performs an intermediate repair of a wound on the face, ears, eyelids, nose, lips, and/or mucous membranes that is between 7.6 and 12.5 cm in size. This code should not be used for smaller or larger wounds, as there are specific codes available for those scenarios.

6. Documentation requirements

To support a claim for CPT code 12054, the healthcare professional must document the following information:

• Size and location of the wound
• Details of the repair procedure performed
• Extent of debridement, if applicable
• Type of anesthesia administered
• Any additional closure methods used, such as Dermabond
• Any complications or unusual findings
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT code 12054, ensure that the wound being repaired meets the size criteria of 7.6 to 12.5 cm. This code should not be reported for smaller or larger wounds. It is important to accurately document the details of the procedure and any additional closure methods used. CPT code 12054 should not be reported with other repair codes for the same wound. It is also important to follow any specific guidelines or requirements from the payer when submitting the claim.

8. Historical information

CPT code 12054 was added to the Current Procedural Terminology system on January 1, 1990. On January 1, 2009, the code description was changed to specify the layer closure of wounds of the face, ears, eyelids, nose, lips, and/or mucous membranes.

9. Examples

1. A patient presents with a 9 cm laceration on their cheek. The healthcare professional performs an intermediate repair of the wound using sutures and Dermabond.
2. A patient sustains a 10 cm laceration on their nose. The healthcare professional performs an intermediate repair of the wound, ensuring proper alignment and closure.
3. A patient has a 12 cm laceration on their lip. The healthcare professional performs an intermediate repair, suturing the inner and outer layers of the wound.
4. A patient has an 8 cm laceration on their eyelid. The healthcare professional performs an intermediate repair, carefully suturing the wound to achieve optimal cosmetic and functional outcomes.
5. A patient presents with a 7.8 cm laceration on their ear. The healthcare professional performs an intermediate repair, ensuring proper alignment and closure of the wound.
6. A patient sustains a 10.5 cm laceration on their mucous membrane. The healthcare professional performs an intermediate repair, suturing the wound to promote healing and prevent infection.
7. A patient has a 7.7 cm laceration on their lip. The healthcare professional performs an intermediate repair, using sutures and Dermabond to achieve a secure closure.