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CPT Code 12031 – Laceration Repair Billing Guide
- What CPT Code 12031 Covers: Intermediary repair of facial wounds (2.6 cm – 5.0 cm) concerning layered closure
- Session Duration Requirements: Not time-based, but detailed documentation is required
- Who Can Use the Code: ER doctors, dermatologists, plastic surgeons, urgent care providers
- Best Practices: Measure and document wound size, apply correct modifiers, differentiate from simple or complex repair codes.
Many providers and billing professionals struggle with knowing when to use CPT Code 12031 versus similar codes, or how to apply modifiers like -26 or -59. If coded incorrectly, it can lead to claim denials, payment delays, or compliance issues. Let’s break it down simply so you can confidently bill this procedure.
What Is CPT Code 12031?
CPT Code 12031 describes an intermediate repair for wounds on areas like the face, nose, ears, eyelids, or lips that are between 2.6 cm and 5.0 cm in length. This procedure involves closing the wound in layers, including the subcutaneous tissue beneath the skin and the dermis, rather than a simple surface closure.
It goes beyond simple skin repair and often involves meticulous suturing of underlying tissue to promote proper healing and reduce scarring.
This wound repair CPT code is essential for accurately medical billing services performed during facial laceration repairs and ensuring that reimbursement reflects the complexity of the procedure.
Who Can Bill CPT Code 12031?
The following licensed professionals are typically eligible to bill CPT Code 12031:
- Emergency room physicians
- Dermatologists
- Plastic surgeons
- Urgent care providers
- General practitioners (in walk-in or outpatient settings)
Always verify your payer-specific rules and scope of practice for eligibility before billing.
Services Covered Under CPT Code 12031
This code applies when an intermediate closure is necessary. The key elements of CPT Code 12031 include:
- Lacerations on face, ears, eyelids, nose, or lips
- Wound size between 6 cm and 5.0 cm
- Closing of one or more layers lowers the skin (e.g., dermis or subcutaneous tissues)
- Includes wound cleaning, minimal debridement, and layered closure
It’s commonly used in facial trauma, sports injuries, or accidental cuts where aesthetics and precise tissue alignment are critical.
Time Requirements (If Applicable)
CPT Code 12031 is not a time-constructed procedure code. Billing is based on:
- Wound location
- Length of the laceration
- Depth and complexity of the repair
However, documentation should still include time spent, materials used, and method of repair for full transparency and compliance.
Modifier Use with CPT Code 12031
To ensure clean claims, use the appropriate CPT modifiers depending on the billing context:
- Modifier 59 – If multiple wound repairs were done at different sites or in distinctly separate sessions
- Modifier 51 – Used when more than one procedure is performed in a single visit, allowing proper payment for each.
- Modifier 25 – Added when a separately billable Evaluation and Management (E/M) service is done on the same day as another procedure.
- Modifier 76 – Applied when the same provider repeats a procedure during the same session or on the same day.
Accurate modifier usage avoids claim denials or bundling errors, especially in multi-laceration cases.
Common Billing Mistakes to Avoid
Avoid the following errors when billing CPT 12031 to prevent delays or denials:
- Using CPT 12031 for simple closures (use CPT 12001–12007 instead)
- Failing to measure and document wound length
- Missing anatomical site in documentation
- Bundling with unrelated procedures without modifiers
- Improper coding for wound size (e.g., coding CPT 12031 for a 1.5 cm laceration)
Clear, detailed documentation is your best defense against audit risk or payer disputes.
Reimbursement Rates for CPT Code 12031
Reimbursement varies based on payer type and whether the procedure was done in a facility or non-facility setting.
- Medicare (2025 National Average):$140–$165, depending on the location and RVU
- Private Payers: May reimburse higher based on regional fee schedules and contract terms
Make sure to check your local MAC or private payer fee schedule for the exact rates.
Difference between CPT Code 12031 and Related Codes
CPT Code Description
12001 Simple repair of apparent wounds (face, 2.5 cm or less)
12011 Simple restoration of 2.6 cm to 7.5 cm (face)
12031 Intermediary repair of face (2.6 cm to 5.0 cm)
12032 Intermediate repair (5.1 cm to 7.5 cm)
13131 Complex repair (face, 1.1 to 2.5 cm)
Knowing the differences between simple, intermediate, and complex laceration repairs is crucial for proper CPT code selection and accurate payment.
Final Thoughts
CPT Code 12031 is a frequently used procedure code in emergency and outpatient settings for facial laceration repairs requiring layered closure. Ensuring accurate documentation, appropriate modifier use, and compliance with payer policies can streamline billing and reduce claim denials.
By understanding when and how to use CPT 12031, providers and medical billing teams can maximize reimbursement while delivering quality care.
Frequently Asked Questions (FAQs)
CPT 12031 is used for reporting an intermediate repair of a wound between 2.5 cm or less, typically involving layered closure.
While both are intermediate repairs, CPT 12031 covers wounds 2.5 cm or less, whereas CPT 12032 applies to wounds from 2.6 cm to 7.5 cm.
Yes, it can be billed alongside ED services when the repair is performed, but appropriate modifiers and documentation may be required.
The operative note should detail wound size, location, closure method, and whether layered closure was performed.
Yes, local anesthesia for the wound repair is considered part of the procedure and is not billed separately.
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