Intermediate vs Complex Repair

Ever confused on the difference between an intermediate repair vs complex repair? Here is a quick video I made to help you better understand the main difference between the two.

According to Current Procedural Terminology (CPT) coding - If you decide to undermine after you repair a standard linear excision, you essentially have 2 types of closure repairs dependent on how much you undermine:

Intermediate repair
Complex repair

In the picture on the left, this is a diagram showing you what the intermediate repair looks like when undermining. On the right, this is a complex repair when undermining.

Under the Current Procedural Terminology (CPT) coding-

INTERMEDIATE REPAIR undermining is defined as “undermining the distance less than the maximum width of the defect, measured perpendicular to the closure line, along at least one entire edge of the defect”. If you look at the pink ellipse on the left, you can see the maximum width of the defect is measured at 1.5 cm.

Then you can see with the red arrows, which is perpendicular to the line of closure, undermining is 1 cm away from the entire one edge of the wound.

Since the distance of undermining (1cm) is less than the maximum width of the defect (1.5 cm), then that is NOT considered extensive undermining and coded and labeled as an “intermediate closure”.

COMPLEX REPAIRS are defined as if you perform “extensive undermining”.

Extensive undermining is defined as “undermining the distance equal to or greater than the maximum width of the defect, measured perpendicular to the closure line, along at least one entire edge of the defect.”

On the right slide, you can see that the maximum width of the defect in pink is still at 1.5 cm. Then you can see with the red arrows, which is perpendicular to the line of closure, undermining is also 1.5 cm away from the entire one edge of the elliptical defect.

Because that distance of undermining is the same (1.5cm) as the maximum width of the defect (1.5cm), then that is considered “extensive undermining”. Therefore, labeled and coded as a “complex repair”.

Note, If undermining distance is greater than 1.5 cm…then that, too, defines a “complex repair” as long as it is equal or greater than the maximum width of the defect (1.5 cm).

Now next time you perform a standard excision on your patient, I hope you keep this in mind!

Serving with GRATITUDE,

Theresa Talens DNP, FNP-C

P.U.L.S.E. Dermatology & Procedures, Inc.

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