Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less
💬 Plain Language Explanation
What this means
This is intermediate wound repair - stitches or sutures for a smaller wound that required more than simple closure.
Why you might see this
This code is used when you received stitches for a smaller wound that required more than simple closure. The wound might have been deeper or required multiple layers of stitches.
Common context
Used for smaller wound repairs that require more than simple 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 intermediate repair of wounds 2.5 cm or less requiring layered closure
Common Scenarios
Documentation Requirements
- Location and length of wound
- Depth of wound
- Closure technique (layered)
- Number of layers closed
- Any complications
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes intermediate closure
- Includes local anesthesia
- Complex closure coded separately
- Simple closure coded separately
- Multiple wounds repaired coded separately
Exclusions
- 12001 (simple repair)
- 13100 (complex repair)
- 12051 (intermediate repair of face)
Coding Notes
Clinical scenarios
- Location and length of wound
- Depth of wound
- Closure technique (layered)
- Location and length of wound
- Depth of wound
- Closure technique (layered)
- Location and length of wound
- Depth of wound
- Closure technique (layered)
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Ask a QuestionFrequently Asked Questions
CPT 12031 is the billing code for "Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less". For intermediate repair of wounds 2.5 cm or less requiring layered closure
Medicare pays approximately $252.95 for CPT 12031 (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 12031 has a total RVU of 5.95, broken down as: Work RVU 2.50, Practice Expense RVU 3.20, and Malpractice RVU 0.25. RVUs (Relative Value Units) determine Medicare reimbursement rates.
Key documentation requirements for CPT 12031 include: Location and length of wound; Depth of wound; Closure technique (layered); Number of layers closed. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 12031: Includes intermediate closure. Includes local anesthesia Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 12031 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 12031 is 15-30 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.