For clean, non-contaminated surgical wounds, linear closures are classified according to CPT® terminology as follows:
- A single layer of repair (e.g. sutures, staples, adhesives)
- Intermediate: the elements of a simple linear closure PLUS
- Limited undermining (less than width of wound)
- A deeper layer of closure (e.g. buried absorbable sutures)
- Complex: the elements of an intermediate closure PLUS AT LEAST ONE OF:
- Free margin location (e.g. nostril, helical rim of ear, vermilion border of lip)
- Exposed structures (bone, cartilage, neurovascular, etc)
- Retention suture
- Extensive undermining (measured from perpendicular line of closure and greater than the width of the wound)
Both the SUTUREGARD® ISR Retention Suture Device for skin relaxation and the HEMIGARD™ Adhesive Retention Suture Device involve the use of retention sutures and are registered as suture retention devices (21CFR878.4930).
For informational purposes, the following chart highlights the difference in reimbursement* between intermediate and complex linear closure:
Due to the Multiple Surgery Reduction Rule, reimbursement of a linear closure is reduced if it is performed on the same day as a higher RVU procedure (e.g. Mohs surgery) as follows*:
*Calculated as RVU of each procedure multiplied by 2020 Medicare multiplier ($36.09 per RVU).