Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 20.1 cm to 30 cm
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Laceration size >30cm requires exceptional documentation
Occasional12007 for simple repairs >30cm (>12 inches). Extremely uncommon - lacerations this extensive typically require intermediate or complex repair, not simple. High audit risk - must document: exact length, why simple repair appropriate (not layered closure needed), anatomic location allowing such length.
Common Causes
- • Multiple separate lacs incorrectly added to reach >30cm (not same anatomic area)
- • Measured length includes wound curvature/zigzag - should measure straight-line distance
- • Laceration this extensive but documented as simple repair - likely should be intermediate/complex
Resolution Strategy
Provide detailed documentation: 'Linear laceration right lower leg from ankle to knee, measuring 38cm straight-line distance, superficial depth involving only skin layer (not fascia/muscle), clean wound edges allowing simple skin approximation, repaired with 26 simple interrupted 3-0 nylon sutures.' Explain why simple repair appropriate despite length. If layered closure needed (subcutaneous + skin), rebill as intermediate 12034-12037. If extensive undermining/debridement, rebill as complex 13120-13122. Expect audit - provide clear documentation supporting simple technique for such extensive laceration.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For simple, single-layer closure of superficial wounds between 20.1 cm and 30 cm in total combined length
Common Scenarios
Documentation Requirements
- Total combined wound length precisely measured
- Location of all wounds if multiple
- Suture type and total quantity used
- Wound preparation method
- Closure technique for extensive length
Coding Guidelines
Common Modifiers
Bundling Rules
- Sum all simple repair lengths in same anatomic classification
- Local anesthesia included in procedure
- Simple wound preparation bundled
Exclusions
- Wounds over 30 cm use code 12020 or highest appropriate code
- Any layered closure requires intermediate codes
- Complex repairs with undermining use 13100 series
Coding Notes
Clinical scenarios
- Total combined wound length precisely measured
- Location of all wounds if multiple
- Suture type and total quantity used
- Total combined wound length precisely measured
- Location of all wounds if multiple
- Suture type and total quantity used
- Total combined wound length precisely measured
- Location of all wounds if multiple
- Suture type and total quantity used
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Code Details
Medicare Pricing
PFSRVU Breakdown
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Ask a QuestionFrequently Asked Questions
CPT 12007 is the billing code for "Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 20.1 cm to 30 cm". For simple, single-layer closure of superficial wounds between 20.1 cm and 30 cm in total combined length
Medicare pays approximately $222.54 for CPT 12007 (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 12007 has a total RVU of 6.83, broken down as: Work RVU 3.12, Practice Expense RVU 3.41, and Malpractice RVU 0.30. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 12007 is "Laceration size >30cm requires exceptional documentation". 12007 for simple repairs >30cm (>12 inches). Extremely uncommon - lacerations this extensive typically require intermediate or complex repair, not simple. High audit risk - must document: exact length, why simple repair appropriate (not layered closure needed), anatomic location allowing such length. Common causes include: Multiple separate lacs incorrectly added to reach >30cm (not same anatomic area); Measured length includes wound curvature/zigzag - should measure straight-line distance. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 12007 include: Total combined wound length precisely measured; Location of all wounds if multiple; Suture type and total quantity used; Wound preparation method. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 12007: Sum all simple repair lengths in same anatomic classification. Local anesthesia included in procedure Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 12007 include: 51 (Multiple procedures performed), 59 (Distinct procedural service), 78 (Related procedure during postoperative period). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 12007 is 35-45 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.