When you code for the use of tissue adhesives, including Dermabond; Medicare has its own guidelines for reporting this procedure that you need to follow to be reimbursed. You should report G0168 for Medicare patients only. If you are reporting the procedure for a non-Medicare patient, you should use the CPT code that is the equivalent and that is 12001-12018 series (Simple repair of superficial wounds …).
Another tip for reporting this claim to Medicare is you may only use G0168 for Dermabond-only laceration repairs in both the inpatient and outpatient settings. If sutures or staples were also used you will have to report this as a layered laceration code on your medical billing form.
Something you may not be aware of is that Medicare assigns a payment status indicator of “N” to G0168, meaning it represents an incidental service. You can report the code but you won’t receive any reimbursement for it from Medicare payers.
Private payers will have different guidelines, a quick check with the payers to see if they follow Medicare guidelines for this type of procedure will let you know whether or not to expect a reimbursement for the service.
non covered CPT for assistant surgeon 10021 - 17340
10000 series procedure codes that are "Nevers" for Assistant Surgeon
The below table identified procedure codes that are not eligible for reimbursement when reported by an Assistant Surgeon.
10021 11311 11643 12007 14020 15261 15789 16000 19001
10022 11312 11644 12011 14021 15300 15792 16020 19020
10040 11313 11646 12013 14040 15301 15793 16025 19030
10060 11400 11719 12014 14041 15320 15819 16030 19100
10061 11401 11720 12015 14060 15321 15820 16035 19101
10080 11402 11721 12016 14061 15330 15821 16036 19102
10081 11403 11730 12017 14350 15331 15822 17000 19103
10120 11404 11732 12020 15002 15335 15823 17003 19105
10121 11406 11740 12021 15003 15336 15824 17004 19110
10140 11420 11750 12031 15004 15340 15825 17106 19112
10160 11421 11752 12032 15005 15341 15826 17107 19120
10180 11422 11755 12034 15040 15360 15828 17108 19125
11000 11423 11760 12035 15050 15361 15829 17110 19126
11001 11424 11762 12036 15100 15365 15833 17111 19290
11004 11426 11765 12037 15101 15366 15834 17250 19291
11005 11307 11640 12004 13160 15240 15786 15950 17360
11006 11308 11641 12005 14000 15241 15787 15951 17380
11008 11310 11642 12006 14001 15260 15788 15953 19000
11010 11440 11770 12041 15110 15400 15835 17260 19295
11011 11441 11771 12042 15111 15401 15836 17261 19296
11012 11442 11772 12044 15115 15420 15837 17262 19297
11040 11443 11900 12045 15116 15421 15838 17263 19298
11041 11444 11901 12046 15120 15430 15839 17264 19300
11042 11446 11920 12051 15121 15431 15850 17266 19301
11043 11450 11921 12052 15130 15570 15851 17270 19324
11044 11451 11922 12053 15131 15572 15852 17271 19325
11045 11462 11950 12054 15135 15574 15860 17272 19328
11046 11463 11951 12055 15136 15576 15876 17273 19330
11047 11470 11952 12056 15150 15600 15877 17274 19340
11055 11471 11954 13100 15151 15610 15878 17276 19342
11056 11600 11960 13101 15152 15620 15879 17280 19350
11057 11601 11970 13102 15155 15630 15920 17281 19355
11100 11602 11971 13120 15156 15650 15931 17282 19370
11101 11603 11975 13121 15157 15736 15933 17283 19371
11200 11604 11976 13122 15170 15740 15934 17284 19380
11201 11606 11977 13131 15171 15760 15936 17286 19396
11300 11620 11980 13132 15175 15775 15937 17311
11301 11621 11981 13133 15176 15776 15940 17312
11302 11622 11982 13150 15200 15780 15941 17313
11303 11623 11983 13151 15201 15781 15944 17314
11305 11624 12001 13152 15220 15782 15945 17315
11306 11626 12002 13153 15221 15783 15946 17340
When billing Medicare for DERMABOND® Portfolio, it is appropriate to bill either the laceration repair CPT code or the HCPCS for Wound Closure utilizing tissue adhesive. Private payers and Medicaid programs may allow physicians to bill both a CPT and the HCPCS code. Please check with the payer regarding specific coding guidelines.
CPT/HCPCS Codes Level of Complexity 2012 Medicare National Reimbursement Ranges (Physician Office)2012 Medicare National
Reimbursement Ranges (Hospitals) CPT 12001-
12021 Simple $ 93.90 - $ 274.00 $ 49.69 - $ 186.67
CPT 12031- 12057 Intermediate $ 235.20 - $ 618.12 $ 153.17 - $ 402.32
CPT 13100- 13160 Complex $ 108.92 - $ 810.78 $ 75.56 – 810.78
HCPCS G0168 Wound Closure utilizing tissue adhesive(s) only $ 86.03 $ 26.55
SIMPLE REPAIR CPT Codes – Simple Repair Primarily involves a superficial, one layer closure of epidermis, dermis, or subcutaneous tissues 2012 Medicare National Average – Physician Office (Non Facility) 2012 Medicare National Average – Physician (Facility )
12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less $ 93.90 $ 49.69
12002 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cm $ 111.64 $ 64.67
12004 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm $ 131.73 $ 79.65
12005 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 12.6 cm to 20.0 cm $ 170.19 $ 106.20
12006 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 20.1 cm to 30.0 cm $ 205.25 $ 129.68
CPT Codes for Laceration Repair Laceration CPT Medicare 110% Medicare 120% Medicare
Simple/Superficial-Scalp, Neck, Axillae, External Genitalia, Trunk, Extremities
2.5 cm or less 12001 $137.19 $150.91 $164.63 2.6 cm to 7.5 cm 12002 $145.53 $160.08 $174.64 7.6 cm to 12.5 cm 12004 $170.54 $187.59 $204.65 12.6 cm to 20.0 cm 12005 $212.60 $233.86 $255.12 20.1 cm to 30.0 cm 12006 $263.77 $290.15 $316.52
over 30.0 cm 12007 $298.25 $328.08 $357.90 Simple/Superficial-Face, Ears, Eyelids, Nose, Lips, Mucous Membranes
2.5 cm or less 12011 $145.15 $159.67 $174.18
2.6 cm to 5.0 cm 12013 $159.55 $175.51 $191.46
5.1 cm to 7.5 cm 12014 $187.97 $206.77 $225.56
7.6 cm to 12.5 cm 12015 $235.72 $259.29 $282.86
12.6 cm to 20.0 cm 12016 $278.93 $306.82 $334.72
20.1 cm to 30.0 cm 12017
over 30.0 cm 12018
Simple repair codes 12001 - 12021 are used when the wound only involves the epidermis and/or dermis. The wound does not extend into the deeper subcutaneous tissues. The repair is a simple one layer closure and may be performed with the use of tissue adhesives, staples or suture material.
Effective Jan. 1, 2005, code G0168 wound closure using adhesives only, was changed to an APC status indicator of "N" and will no longer be paid separately.
A simple repair reported with code only G0168 will not be reimbursed. The code for the simple repair is assigned from code range 12001-12018 and an additional code for the wound adhesive G0168 may also be assigned.
Correspondence Language Policy/Example Number 3.10000 - CPT Manual or CMS manual coding instruction
For example, the CPT Manual instruction under “Excision - Benign Lesions”, states that the excision includes simple closure. Therefore the procedure described by the column one CPT code 11400 (“Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms, or legs; excised diameter 0.5 cm or less”) includes the procedure described by the column two CPT code 12001 (“Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5cm or less”). CPT code 12001 is bundled into CPT code 11400.
Correspondence Language Policy/Example Number 4.10000 - Mutually exclusive procedures
For example, a physician performing a destruction of a malignant lesion of the arm by laser surgery, electrosurgery, cryosurgery, chemosurgery, or surgical curettement (CPT code 17260) would not also report an excision of the same malignant lesion of the arm (CPT code 11600).
Only one method of treatment of the malignant skin lesion would be performed at a single patient encounter. Therefore, CPT codes 17260 and 11600 are mutually exclusive of each othe
Laceration Repairs
* Repairs – Simple, Intermediate, and Complex (12001-13160)
* CPT® code is selected based on the length of the closure. If two closures of the same type and within the same ‘anatomic category’, combine the lengths and use one code.
NCCI Manual – ATT
* When lesion excision is of such an extent that closure cannot be accomplished by simple, intermediate, or complex closure, other methodology must be employed.
* Frequently adjacent tissue transfer or tissue rearrangement is employed (Z-plasty, W-plasty, flaps, etc.). This family of codes, (CPT® codes 14000-14350), involves excision with adjacent tissue transfer and correlates to excision codes.
Excision CPT® codes (11400-11646) and repair CPT® codes (12001 – 13160) are not to be separately reported when CPT® codes 14000- 14350 are reported.
When billing Medicare for DERMABOND® Portfolio, it is appropriate to bill either the laceration repair CPT code or the HCPCS for Wound Closure utilizing tissue adhesive. Private payers and Medicaid programs may allow physicians to bill both a CPT and the HCPCS code. Please check with the payer regarding specific coding guidelines.
CPT/HCPCS Codes Level of Complexity 2012 Medicare National Reimbursement Ranges (Physician Office)2012 Medicare National
Reimbursement Ranges (Hospitals) CPT 12001-
12021 Simple $ 93.90 - $ 274.00 $ 49.69 - $ 186.67
CPT 12031- 12057 Intermediate $ 235.20 - $ 618.12 $ 153.17 - $ 402.32
CPT 13100- 13160 Complex $ 108.92 - $ 810.78 $ 75.56 – 810.78
HCPCS G0168 Wound Closure utilizing tissue adhesive(s) only $ 86.03 $ 26.55
SIMPLE REPAIR CPT Codes – Simple Repair Primarily involves a superficial, one layer closure of epidermis, dermis, or subcutaneous tissues 2012 Medicare National Average – Physician Office (Non Facility) 2012 Medicare National Average – Physician (Facility )
12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less $ 93.90 $ 49.69
12002 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cm $ 111.64 $ 64.67
12004 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm $ 131.73 $ 79.65
12005 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 12.6 cm to 20.0 cm $ 170.19 $ 106.20
12006 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 20.1 cm to 30.0 cm $ 205.25 $ 129.68
CPT Codes for Laceration Repair Laceration CPT Medicare 110% Medicare 120% Medicare
Simple/Superficial-Scalp, Neck, Axillae, External Genitalia, Trunk, Extremities
2.5 cm or less 12001 $137.19 $150.91 $164.63 2.6 cm to 7.5 cm 12002 $145.53 $160.08 $174.64 7.6 cm to 12.5 cm 12004 $170.54 $187.59 $204.65 12.6 cm to 20.0 cm 12005 $212.60 $233.86 $255.12 20.1 cm to 30.0 cm 12006 $263.77 $290.15 $316.52
over 30.0 cm 12007 $298.25 $328.08 $357.90 Simple/Superficial-Face, Ears, Eyelids, Nose, Lips, Mucous Membranes
2.5 cm or less 12011 $145.15 $159.67 $174.18
2.6 cm to 5.0 cm 12013 $159.55 $175.51 $191.46
5.1 cm to 7.5 cm 12014 $187.97 $206.77 $225.56
7.6 cm to 12.5 cm 12015 $235.72 $259.29 $282.86
12.6 cm to 20.0 cm 12016 $278.93 $306.82 $334.72
20.1 cm to 30.0 cm 12017
over 30.0 cm 12018
Simple repair codes 12001 - 12021 are used when the wound only involves the epidermis and/or dermis. The wound does not extend into the deeper subcutaneous tissues. The repair is a simple one layer closure and may be performed with the use of tissue adhesives, staples or suture material.
Effective Jan. 1, 2005, code G0168 wound closure using adhesives only, was changed to an APC status indicator of "N" and will no longer be paid separately.
A simple repair reported with code only G0168 will not be reimbursed. The code for the simple repair is assigned from code range 12001-12018 and an additional code for the wound adhesive G0168 may also be assigned.
Correspondence Language Policy/Example Number 3.10000 - CPT Manual or CMS manual coding instruction
For example, the CPT Manual instruction under “Excision - Benign Lesions”, states that the excision includes simple closure. Therefore the procedure described by the column one CPT code 11400 (“Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms, or legs; excised diameter 0.5 cm or less”) includes the procedure described by the column two CPT code 12001 (“Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5cm or less”). CPT code 12001 is bundled into CPT code 11400.
Correspondence Language Policy/Example Number 4.10000 - Mutually exclusive procedures
For example, a physician performing a destruction of a malignant lesion of the arm by laser surgery, electrosurgery, cryosurgery, chemosurgery, or surgical curettement (CPT code 17260) would not also report an excision of the same malignant lesion of the arm (CPT code 11600).
Only one method of treatment of the malignant skin lesion would be performed at a single patient encounter. Therefore, CPT codes 17260 and 11600 are mutually exclusive of each othe
Laceration Repairs
* Repairs – Simple, Intermediate, and Complex (12001-13160)
* CPT® code is selected based on the length of the closure. If two closures of the same type and within the same ‘anatomic category’, combine the lengths and use one code.
NCCI Manual – ATT
* When lesion excision is of such an extent that closure cannot be accomplished by simple, intermediate, or complex closure, other methodology must be employed.
* Frequently adjacent tissue transfer or tissue rearrangement is employed (Z-plasty, W-plasty, flaps, etc.). This family of codes, (CPT® codes 14000-14350), involves excision with adjacent tissue transfer and correlates to excision codes.
Excision CPT® codes (11400-11646) and repair CPT® codes (12001 – 13160) are not to be separately reported when CPT® codes 14000- 14350 are reported.
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