What is the CPT (Current Procedural Terminology) code for scar revision?

CPT Codes for Scar Revision

The CPT code for scar revision depends on the size and location of the scar, with codes ranging from 13100-13160 for complex repair procedures.

Understanding CPT Coding for Scar Revision

Scar revision procedures are coded based on several factors including:

• Size of the scar
• Location on the body
• Complexity of the procedure
• Whether the revision is simple or complex

Primary CPT Codes for Scar Revision

For complex repair procedures (which most scar revisions are classified as):

• 13100-13102: Complex repair of trunk (2.6 cm to 7.5 cm)
• 13120-13122: Complex repair of scalp, arms, and/or legs
• 13131-13133: Complex repair of forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet
• 13151-13153: Complex repair of eyelids, nose, ears and/or lips
• 13160: Secondary closure of surgical wound or dehiscence, extensive or complicated

Additional Considerations

1. Documentation Requirements:

   • Detailed operative report describing the technique used
   • Measurements of the scar in centimeters
   • Anatomical location
   • Complexity factors that justify the code selection

2. Modifiers:

   • Use modifier -59 if performing multiple scar revisions in different anatomic sites
   • Use modifier -51 for multiple procedures at the same session

3. Common Coding Pitfalls:

   • Incorrectly coding as simple repair when complex techniques were used
   • Not documenting scar measurements accurately
   • Using excision codes instead of repair codes

Special Circumstances

For scar revisions performed in conjunction with other procedures:

• If addressing a scar from a previous melanoma excision, document whether there is "persistent disease or true local scar recurrence" as defined by the presence of in situ and/or radial growth phase 1
• When performing scar revision with additional procedures, ensure each procedure is properly documented and coded separately

Billing Guidelines

Medicare and most insurance carriers recognize scar revision CPT codes when:

• The procedure is medically necessary (functional impairment)
• Proper documentation supports the medical necessity
• For cosmetic scar revisions, patients should be informed that the procedure may not be covered by insurance

Remember that accurate coding is essential for proper reimbursement and to avoid compliance issues with insurance carriers and Medicare.

For complex cases involving multiple anatomical sites or extensive revisions, consultation with a coding specialist may be beneficial to ensure appropriate code selection and maximum allowable reimbursement.