Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 12.6 cm to 20 cm
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Laceration size documentation missing or outside 12.6-20cm range
Common12005 for simple repairs 12.6-20cm. Lacerations this long uncommon in outpatient setting - payers scrutinize for accurate size documentation. If size <12.6cm, should use lower code. If >20cm, should use 12006 (20.1-30cm) or 12007 (>30cm).
Common Causes
- • Size documented as 'large laceration' - not specific enough, payer assumes smaller code
- • Measured 11.5cm - should be 12004, not 12005
- • Multiple lacs added incorrectly - can't add lacs from different anatomic areas
Resolution Strategy
Document exact length: 'Linear laceration extending from left shoulder to mid-upper arm, measuring 15.3cm total length, repaired with simple interrupted 3-0 nylon sutures, 12 sutures placed.' For multiple lacs same anatomic grouping (face, extremities, trunk), may add total lengths per CPT guidelines. Cannot add lacs from different anatomic groups. If size documented <12.6cm or >20cm, rebill with correct code.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For simple, single-layer closure of superficial wounds between 12.6 cm and 20 cm in total length
Common Scenarios
Documentation Requirements
- Total combined wound length documented
- Individual wound locations if multiple
- Suture materials and quantities
- Wound cleansing and preparation documented
- Closure technique specified
Coding Guidelines
Common Modifiers
Bundling Rules
- Add all simple repair lengths in same anatomic classification
- Local anesthesia bundled into code
- Basic wound preparation included
Exclusions
- Wounds over 20 cm use code 12007
- Layered repairs require intermediate codes
- Repairs with extensive undermining are complex
Coding Notes
Clinical scenarios
- Total combined wound length documented
- Individual wound locations if multiple
- Suture materials and quantities
- Total combined wound length documented
- Individual wound locations if multiple
- Suture materials and quantities
- Total combined wound length documented
- Individual wound locations if multiple
- Suture materials and quantities
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Code Details
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PFSRVU Breakdown
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Ask a QuestionFrequently Asked Questions
CPT 12005 is the billing code for "Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 12.6 cm to 20 cm". For simple, single-layer closure of superficial wounds between 12.6 cm and 20 cm in total length
Medicare pays approximately $171.76 for CPT 12005 (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 12005 has a total RVU of 5.79, broken down as: Work RVU 2.64, Practice Expense RVU 2.89, and Malpractice RVU 0.26. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 12005 is "Laceration size documentation missing or outside 12.6-20cm range". 12005 for simple repairs 12.6-20cm. Lacerations this long uncommon in outpatient setting - payers scrutinize for accurate size documentation. If size <12.6cm, should use lower code. If >20cm, should use 12006 (20.1-30cm) or 12007 (>30cm). Common causes include: Size documented as 'large laceration' - not specific enough, payer assumes smaller code; Measured 11.5cm - should be 12004, not 12005. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 12005 include: Total combined wound length documented; Individual wound locations if multiple; Suture materials and quantities; Wound cleansing and preparation documented. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 12005: Add all simple repair lengths in same anatomic classification. Local anesthesia bundled into code Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 12005 include: 51 (Multiple procedures performed), 59 (Distinct procedural service), 78 (Related procedure during postop period). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 12005 is 25-35 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.