Repair, complex, trunk; 2.6 cm to 7.5 cm
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Add-on complex repair code billed without initial complex repair same session
Occasional13101 (complex repair face each additional 5cm or less) is add-on code requiring initial complex repair 13100-13133 same session. Cannot bill 13101 alone. For complex facial repair >1.0cm, bill: 13100 (first 1.0cm) + 13101 (each additional 5cm). Must document total length and complex technique.
Common Causes
- • Billed 13101 without 13100 - add-on requires base code
- • Total repair 3.5cm but only 13100 billed - need 13100 + 13101
- • Complex technique not documented for total repair length
Resolution Strategy
Document total complex repair length: 'Complex facial laceration forehead to eyebrow, 4.2cm total length. Extensive undermining performed. Three-layer closure: muscle, subcutaneous, skin. Total length 4.2cm.' Bill: 13100 (first 1.0cm) + 13101 (additional 3.2cm, rounds to 5cm). If <1.0cm total, bill 13100 only. If technique not complex for full length, may need to bill initial portion as complex and additional as intermediate. Cannot bill 13101 without 13100 same session.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For complex repairs of trunk wounds 2.6-7.5 cm requiring layered closure with extensive undermining, tissue rearrangement, or debridement of complicated lacerations
Common Scenarios
Documentation Requirements
- Detailed wound measurements
- Documentation of tissue layers closed
- Extent and method of undermining
- Debridement performed if applicable
- Suture materials for each layer
- Any retention techniques used
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes extensive undermining and layered closure
- Complex debridement of contaminated wounds included
- Local or regional anesthesia bundled
Exclusions
- Intermediate repairs use codes 12031-12057
- Tissue transfers or grafts coded separately with 14000 or 15000 series
- Simple debridement without complex closure
Coding Notes
Clinical scenarios
- Detailed wound measurements
- Documentation of tissue layers closed
- Extent and method of undermining
- Detailed wound measurements
- Documentation of tissue layers closed
- Extent and method of undermining
- Detailed wound measurements
- Documentation of tissue layers closed
- Extent and method of undermining
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Code Details
Medicare Pricing
PFSRVU Breakdown
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Ask a QuestionFrequently Asked Questions
CPT 13101 is the billing code for "Repair, complex, trunk; 2.6 cm to 7.5 cm". For complex repairs of trunk wounds 2.6-7.5 cm requiring layered closure with extensive undermining, tissue rearrangement, or debridement of complicated lacerations
Medicare pays approximately $381.37 for CPT 13101 (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 13101 has a total RVU of 12.82, broken down as: Work RVU 5.83, Practice Expense RVU 6.42, and Malpractice RVU 0.57. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 13101 is "Add-on complex repair code billed without initial complex repair same session". 13101 (complex repair face each additional 5cm or less) is add-on code requiring initial complex repair 13100-13133 same session. Cannot bill 13101 alone. For complex facial repair >1.0cm, bill: 13100 (first 1.0cm) + 13101 (each additional 5cm). Must document total length and complex technique. Common causes include: Billed 13101 without 13100 - add-on requires base code; Total repair 3.5cm but only 13100 billed - need 13100 + 13101. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 13101 include: Detailed wound measurements; Documentation of tissue layers closed; Extent and method of undermining; Debridement performed if applicable. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 13101: Includes extensive undermining and layered closure. Complex debridement of contaminated wounds included Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 13101 include: 22 (Increased procedural services), 51 (Multiple procedures same session), 59 (Distinct procedural service). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 13101 is 60-90 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.