Repair, complex, trunk; 1.1 cm to 2.5 cm
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Simple or intermediate repair billed as complex - technique doesn't support complexity
Common13100 (complex repair face ≤1.0cm) requires layered closure PLUS extensive undermining, stented dressings, or >one-layer closure with scar revision/debridement. Simple layered closure = intermediate (12051-12057), not complex. Denied when documentation shows intermediate technique billed as complex.
Common Causes
- • Layered closure documented but no undermining/revision - that's intermediate 12051, not complex 13100
- • Two-layer closure (subcutaneous + skin) alone doesn't qualify as complex - need additional criteria
- • Complex repair code used for location (face) but technique only intermediate
Resolution Strategy
Document complex criteria: 'Facial laceration right cheek, 0.8cm. Complex repair required due to irregular wound edges. Extensive undermining performed to achieve tension-free closure. Wound edges debrided to fresh tissue. Three-layer closure: deep absorbable sutures to muscle, subcutaneous layer with absorbable sutures, skin with 6-0 nylon interrupted sutures.' Must show: layered closure PLUS (undermining >than wound length, scar revision, debridement >2.5cm, retention sutures, stents). If only layered closure, rebill as intermediate 12051. Cannot appeal without documented complex criteria beyond layering.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For complex repair of trunk wounds 1.1 to 2.5 cm requiring advanced techniques
Common Scenarios
Documentation Requirements
- Location and length of wound
- Complexity of repair
- Closure technique used
- Any flaps or grafts used
- Any complications
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes complex closure
- Includes local anesthesia
- Simple closure coded separately
- Intermediate closure coded separately
- Skin grafts coded separately
Exclusions
- 12001 (simple repair)
- 12031 (intermediate repair)
- 13120 (complex repair of face)
Coding Notes
Clinical scenarios
- Location and length of wound
- Complexity of repair
- Closure technique used
- Location and length of wound
- Complexity of repair
- Closure technique used
- Location and length of wound
- Complexity of repair
- Closure technique used
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Ask a QuestionFrequently Asked Questions
CPT 13100 is the billing code for "Repair, complex, trunk; 1.1 cm to 2.5 cm". For complex repair of trunk wounds 1.1 to 2.5 cm requiring advanced techniques
Medicare pays approximately $328.32 for CPT 13100 (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 13100 has a total RVU of 10.75, broken down as: Work RVU 4.50, Practice Expense RVU 5.80, and Malpractice RVU 0.45. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 13100 is "Simple or intermediate repair billed as complex - technique doesn't support complexity". 13100 (complex repair face ≤1.0cm) requires layered closure PLUS extensive undermining, stented dressings, or >one-layer closure with scar revision/debridement. Simple layered closure = intermediate (12051-12057), not complex. Denied when documentation shows intermediate technique billed as complex. Common causes include: Layered closure documented but no undermining/revision - that's intermediate 12051, not complex 13100; Two-layer closure (subcutaneous + skin) alone doesn't qualify as complex - need additional criteria. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 13100 include: Location and length of wound; Complexity of repair; Closure technique used; Any flaps or grafts used. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 13100: Includes complex closure. Includes local anesthesia Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 13100 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 13100 is 30-60 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.