Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Laceration size exceeds code limit - should use higher code
Very Common12001 covers simple laceration repair 2.5cm or less. Laceration 2.6-5cm = 12002, 5.1-7.5cm = 12004, 7.6-12.5cm = 12005, etc. Downcoding/denial occurs when documented size exceeds 2.5cm but 12001 billed. Must measure and document actual wound length accurately.
Common Causes
- • Laceration measured 3.2cm - should bill 12002 not 12001
- • Wound measured in inches (1.5 inches = 3.8cm) - conversion error led to wrong code
- • Size not documented - payer assumes smallest code and denies upgrade
Resolution Strategy
Document exact wound length: 'Linear laceration right forearm measuring 2.3cm repaired with simple closure, 4-0 nylon interrupted sutures.' Measure before repair (after cleaning). If size documented >2.5cm, rebill with correct code: 2.6-5cm = 12002, 5.1-7.5cm = 12004. Cannot appeal without size documentation. Size determines code selection, not complexity of repair.
2. Complex repair technique documented - simple repair code inappropriate
Common12001 is for simple repair (single-layer closure of skin). If documentation shows layered closure (subcutaneous + skin), extensive undermining, or complex technique, should bill intermediate (12031-12057) or complex repair (13100+) codes. Simple repair code denied when technique documented exceeds simple closure.
Common Causes
- • Documentation states 'layered closure' - that's intermediate repair 12031-12037, not simple 12001
- • Subcutaneous sutures placed then skin closure - two-layer = intermediate, not simple
- • Extensive debridement before closure - may elevate to complex repair if >2.5cm debridement
Resolution Strategy
Match code to technique documented: Single-layer skin closure only = simple repair (12001-12021), Layered closure (subcutaneous + skin) or contaminated wound requiring extensive cleaning = intermediate (12031-12057), Layered closure WITH undermining/extensive debridement/retention sutures = complex (13100-13160). If technique truly simple (skin only), 12001 appropriate. If layered closure documented, rebill as intermediate 12031 (2.5cm or less) or higher. Document technique clearly to support code selected.
💬 Plain Language Explanation
What this means
This is simple wound repair - basic stitches or sutures for a straightforward wound closure.
Why you might see this
This code is used when you received simple stitches for a straightforward wound. The wound didn't require complex repair or multiple layers of stitches.
Common context
Used for simple wound repairs that don't require complex closure, often in emergency departments or urgent care.
What to ask your provider
"'What type of wound was repaired? How many stitches were needed? When can the stitches be removed?'"
Relative Value Units (RVUs)
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Clinical Information
When to Use
For simple repair of superficial wounds 2.5 cm or less on specified body areas
Common Scenarios
Documentation Requirements
- Location and length of wound
- Depth of wound
- Closure technique
- Number of sutures used
- Any complications
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes simple closure
- Includes local anesthesia
- Complex closure coded separately
- Intermediate closure coded separately
- Multiple wounds repaired coded separately
Exclusions
- 12031 (intermediate repair)
- 13100 (complex repair)
- 12011 (simple repair of face)
Coding Notes
Clinical scenarios
- Location and length of wound
- Depth of wound
- Closure technique
- Location and length of wound
- Depth of wound
- Closure technique
- Location and length of wound
- Depth of wound
- Closure technique
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Ask a QuestionFrequently Asked Questions
CPT 12001 is the billing code for "Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less". For simple repair of superficial wounds 2.5 cm or less on specified body areas
Medicare pays approximately $91.22 for CPT 12001 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 12001 has a total RVU of 2.82, broken down as: Work RVU 1.20, Practice Expense RVU 1.50, and Malpractice RVU 0.12. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 12001 is "Laceration size exceeds code limit - should use higher code". 12001 covers simple laceration repair 2.5cm or less. Laceration 2.6-5cm = 12002, 5.1-7.5cm = 12004, 7.6-12.5cm = 12005, etc. Downcoding/denial occurs when documented size exceeds 2.5cm but 12001 billed. Must measure and document actual wound length accurately. Common causes include: Laceration measured 3.2cm - should bill 12002 not 12001; Wound measured in inches (1.5 inches = 3.8cm) - conversion error led to wrong code. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 12001 include: Location and length of wound; Depth of wound; Closure technique; Number of sutures used. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 12001: Includes simple closure. Includes local anesthesia Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 12001 include: 51 (Multiple procedures performed same session), 59 (Distinct procedural service if performed separately), LT (Left side procedure). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 12001 is 5-15 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.