Complex Wound Closure / Local Flap
1310013101wRVU: 3.41 — Complex repair, trunk, 2.6-7.5 cm (standalone primary code — mutually exclusive with 13100; select based on wound length; 3.41 wRVU, 10-day global)13102wRVU: 1.21 — Complex repair, trunk, each additional 5 cm (true CPT add-on to 13100 or 13101; 1.21 wRVU)13151wRVU: 4.23 — Complex repair, eyelids/nose/ears/lips, 1.1-2.5 cm (standalone primary; 4.23 wRVU, 10-day global) — use instead of 13131 for these specific sites13152wRVU: 5.21 — Complex repair, eyelids/nose/ears/lips, 2.6-7.5 cm (standalone primary; 5.21 wRVU, 10-day global)14000wRVU: 6.21 — Adjacent tissue transfer (Z-plasty, rotation flap, transposition flap), trunk; defect 10 sq cm or less (6.21 wRVU, 90-day global)14001wRVU: 8.56 — Adjacent tissue transfer, trunk; defect 10.1-30 sq cm (8.56 wRVU, 90-day global)14020wRVU: 7.04 — Adjacent tissue transfer, scalp, arms, or legs; defect 10 sq cm or less (7.04 wRVU, 90-day global)14021wRVU: 9.48 — Adjacent tissue transfer, scalp, arms, or legs; defect 10.1-30 sq cm (9.48 wRVU, 90-day global)14040wRVU: 8.39 — Adjacent tissue transfer, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; defect 10 sq cm or less (8.39 wRVU, 90-day global) — NOTE: this is NOT the scalp/arm/leg code; use 14020 for those sites14060wRVU: 9.0 — Adjacent tissue transfer, eyelids, nose, ears, and/or lips; defect 10 sq cm or less (9.00 wRVU, 90-day global)
Complex wound [location] requiring reconstruction
Same
Complex wound closure [with / without] local flap, [location]
[Attending name], MD
[Resident/Fellow/PA name]
Local with sedation / general
Patient presents with [traumatic wound / post-excision defect / dehisced wound] measuring [X x Y] cm on the [location]. Primary closure [not possible due to tension / skin deficiency / location]. [Reconstructive ladder assessed.] Local tissue rearrangement planned. Risks including wound dehiscence, infection, flap necrosis, and scarring discussed. Consent obtained.
Wound [X x Y] cm. Wound bed [clean / granulating / with exposed [tendon / bone / hardware]]. Local tissue mobility adequate for [rotation / advancement / transposition] flap. [No signs of infection.]
The patient was positioned and prepped in sterile fashion. Local anesthesia infiltrated [1% lidocaine with 1:100,000 epinephrine].
The wound was debrided of all non-viable tissue and margins freshened. The defect measured [X x Y] cm. [Reconstructive plan: rotation flap / advancement flap / Z-plasty / rhomboid flap / bilobed flap.]
[Rotation flap:] A rotation flap was designed with a radius approximately 2.5-3 times the defect diameter. The flap was incised and elevated in the [subcutaneous / submuscular] plane. The flap was rotated to cover the defect without tension. Donor site [closed primarily / covered with STSG].
[Z-plasty:] The Z-plasty limbs were designed at [60-degree] angles to the central limb, with all three limbs of equal length. Flaps elevated and transposed. This effectively lengthened the scar by 75% and reoriented it along relaxed skin tension lines.
All layers closed in sequence: deep dermis with 3-0 Vicryl, skin with 4-0 Monocryl subcuticular [or nylon interrupted]. Wound approximation without tension confirmed. Dressing applied. Patient tolerated the procedure well.
None
[Wound margin biopsy sent / None]
Minimal
[Drain placed / None]
Patient discharged to home / PACU in stable condition.
Epic SmartPhrase Version
PREOPERATIVE DIAGNOSIS: Complex wound, [location], requiring reconstruction
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Complex wound closure [with local flap: rotation / advancement / Z-plasty], [location]
ATTENDING SURGEON: ***, MD/DO
FIRST ASSISTANT: ***
ANESTHESIA: [Local with sedation / general]
INDICATIONS: The patient is a .PTAGE-year-old .PTSEX with a [traumatic wound / post-excision defect / dehisced wound] measuring *** × *** cm on the [location]. Primary closure not possible due to [tension / skin deficiency]. Local tissue rearrangement planned. Risks including wound dehiscence, infection, flap necrosis, and scarring were discussed. Informed consent obtained.
FINDINGS: Wound *** × *** cm. Wound bed [clean / granulating / with exposed tendon/bone]. Local tissue mobility adequate for [rotation / advancement / transposition] flap. No signs of infection.
DESCRIPTION OF PROCEDURE:
Patient positioned and prepped in sterile fashion. 1% lidocaine with 1:100,000 epinephrine infiltrated. Wound debrided of non-viable tissue. Margins freshened. Defect measured *** × *** cm. [ROTATION FLAP: Flap designed with radius approximately 2.5-3 times the defect diameter; elevated in the [subcutaneous / submuscular] plane; rotated to cover defect without tension; donor site closed primarily.] [Z-PLASTY: Limbs designed at 60-degree angles to central limb, all three limbs equal length; flaps elevated and transposed, lengthening scar by 75% and reorienting along relaxed skin tension lines.] [ADVANCEMENT FLAP: *** × *** cm flap raised; advanced to cover defect.] Deep dermis closed with 3-0 Vicryl, skin with 4-0 Monocryl subcuticular. Wound approximation without tension confirmed. Dressing applied. Patient tolerated the procedure well.
ESTIMATED BLOOD LOSS: Minimal
SPECIMENS: [Wound margin biopsy / None]
COMPLICATIONS: None
DRAINS: [Drain placed / None]
DISPOSITION: Patient taken to PACU in stable condition. Discharged to home.
Signed: .ME, .MYDEGREE
.TODAYVariants
Rhomboid (Limberg) flap
For rhomboid-shaped defects. Classic Limberg design uses 60° and 120° opposing angles. Document flap elevation and transposition. For modified designs (Dufourmentel), document the alpha angle used.
Bilobed flap
For nasal tip and lateral nose defects. Zitelli modification — total rotational arc 90-110°, each lobe rotated approximately 45-50° off prior axis; first lobe 80-100% of defect diameter, second lobe 80% of first lobe. Document nasal anatomy preservation and relationship to alar rim.
Keystone flap
For extremity and trunk defects. Curvilinear trapezoidal perforator island flap (Behan 2003). Document perforator preservation, deep fascia release for advancement, and 1:1 defect-to-flap width ratio.
Charting Tips
- CPT selection depends on surface area (complex repair 13xxx) vs. flap type (adjacent tissue transfer 14xxx) — these code families cannot be combined for the same wound
- Document wound dimensions, location, and total wound length (cm) as these drive CPT selection
- {'For complex repair': 'explicitly document the qualifying element (bone/tendon/cartilage exposure, debridement, retention sutures, extensive undermining with measured distance, or free margin involvement)'}
- {'For adjacent tissue transfer': 'document defect area in sq cm (primary defect PLUS secondary defect created by flap design — the sum determines the 14xxx tier)'}
- State flap design, pedicle, and degree of transposition/advancement
- Document tension at closure and any retention sutures
- For exposed hardware or bone: document coverage achieved and wound bed vascularity
Billing Tips
- Code selection depends on anatomic region and total wound length. Trunk (13100-13102): 13100 (1.1-2.5 cm, 2.93 wRVU), 13101 (2.6-7.5 cm, 3.41 wRVU), +13102 add-on per each additional 5 cm (1.21 wRVU). Scalp/arm/leg (13120-13122): 13120 (1.1-2.5 cm, 3.15 wRVU), 13121 (2.6-7.5 cm, 3.90 wRVU), +13122 add-on (1.40 wRVU). Forehead/cheeks/chin/mouth/neck/axillae/genitalia/hands/feet (13131-13133): 13131 (1.1-2.5 cm, 3.64 wRVU), 13132 (2.6-7.5 cm, 4.66 wRVU), +13133 add-on (2.14 wRVU). Eyelids/nose/ears/lips (13151-13153): 13151 (1.1-2.5 cm, 4.23 wRVU), 13152 (2.6-7.5 cm, 5.21 wRVU), +13153 add-on (2.32 wRVU) — do not use 13131-13133 for eyelids, nose, ears, or lips.
- Measure and document the total wound length in cm. This drives code tier selection and is auditable.
- Add-on codes (13102, 13122, 13133, 13153) are used for each additional 5 cm beyond the initial segment. Bill once per additional 5 cm or fraction thereof.
- Complex repair requires layered closure PLUS at least one of: (1) exposure of bone, cartilage, tendon, or named neurovascular structure; (2) debridement of wound edges; (3) extensive undermining — defined since 2020 CPT update as undermining at least equal to the maximum wound width measured perpendicular to the closure line along at least one entire edge; (4) involvement of a free margin (helical rim, vermillion border, nostril rim); or (5) placement of retention sutures. Layered closure alone qualifies only as intermediate repair (12031-12057). 'Scar revision' was removed from the complex repair definition in the 2020 CPT update and is no longer a qualifying criterion. Document which specific element justifies the complex code — payers routinely downcode to intermediate without this documentation.
- If multiple wounds are closed, total wound lengths within the same CPT anatomic group (wounds must share the same complexity classification). Wounds of different complexity or different anatomic groups are billed separately.
- Global periods differ by code family: complex repair codes 13100-13153 carry a 10-day global (minor surgery). Adjacent tissue transfer codes 14000-14061 carry a 90-day global (major surgery). Do not apply the 10-day rule to flap codes. Post-op wound checks within the applicable global period are bundled; unexpected complications requiring return to OR can be unbundled with modifier -78.
- NCCI bundling: complex repair codes (13100-13153) and adjacent tissue transfer codes (14000-14061) cannot be reported together for the same lesion or wound. Adjacent tissue transfer codes include the repair/closure in their value. Use one family or the other per wound.
- Do not downcode to intermediate repair (12xxx). If the closure qualifies as complex, document the qualifying element and bill correctly.
General coding reference. Verify with your institution’s billing department before submitting claims.