Secondary closure of an extensively dehisced or complicated surgical wound, requiring reopening, debridement of non-viable tissue, and layered repair.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $740.83
- Total RVUs
- 22.18
- Global, days
- 90
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 6 cited references ↓
- Reason the wound was not closed primarily or description of dehiscence event, including timing and clinical findings
- Wound dimensions (length in centimeters) and anatomic location documented explicitly
- Description of debridement performed: amount of non-viable tissue removed, method used
- Documentation of undermining, retention sutures, or other techniques that justify complex-level closure
- Layered closure technique described by layer (subcutaneous, fascial, dermal, epidermal)
- If performed during a global period: clear statement that this closure was staged, unplanned, or unrelated to the original procedure
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 6 cited references ↓
CPT 13160 covers secondary closure of a surgical wound that has dehisced or failed to heal — typically a wound left intentionally open, reopened due to infection, or too contaminated at the original surgery to close primarily. The procedure involves wound bed preparation (debridement, irrigation), undermining of tissue flaps, and layered closure. It is not a simple suture pass; the complexity and extent of tissue work is what separates it from intermediate repair codes.
The 90-day global period means any routine wound care, dressing changes, and follow-up visits related to this closure are bundled through day 90. If the closure is performed during the post-op period of a prior surgery by the same physician, modifier 58 applies when it was planned or staged, and modifier 78 applies when the return to OR was unplanned and the dehiscence is related to the original procedure.
NCI bundling rules prohibit separately billing debridement (e.g., 11042–11047) or adjacent tissue transfer codes (14000–14350) for the same wound on the same day. Wound closure that is inherent to gaining surgical exposure for a deeper repair — tendon, nerve, vessel — is not separately reportable as 13160 unless the closure itself required substantially greater work beyond what the primary procedure entailed, and that work is explicitly documented.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 11.74 |
| Practice expense RVU | 8.34 |
| Malpractice RVU | 2.1 |
| Total RVU | 22.18 |
| Medicare national rate | $740.83 |
| Global period | 90 days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $740.83 |
HOPD (APC 5055) Hospital outpatient department | $3,620.48 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $1,940.78 |
Common denial reasons
The recurring reasons claims for CPT 13160 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Bundled with the primary procedure when closure is inherent to surgical exposure (e.g., tendon or vessel repair) and not separately documented
- Debridement code billed same-day for same wound triggers NCCI PTP edit — requires modifier or separate lesion documentation
- Adjacent tissue transfer (14000–14350) billed same wound same day — mutually exclusive under NCCI Chapter 3
- Missing modifier when submitted during another procedure's global period — payers deny without 58 or 78
- Operative note documents 'standard closure' or 'wound closed in layers' without detailing complexity, undermining, or tissue condition — fails audit for 13160 complexity threshold
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01Can 13160 be billed during the global period of the original surgery?
02Can debridement be billed separately on the same day as 13160?
03Does 13160 require a specific wound length measurement?
04Is 13160 billable when wound closure is part of a deeper repair like tendon or nerve work?
05Can adjacent tissue transfer (14000–14350) be billed same-day with 13160 for the same wound?
06What distinguishes 13160 from intermediate repair codes when a wound reopens?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/files/document/03-chapter3-ncci-medicare-policy-manual-2025finalcleanpdf.pdf
- 03cms.govhttps://www.cms.gov/files/document/medicaid-ncci-policy-manual-2022-chapter-3.pdf
- 04aapc.comhttps://www.aapc.com/discuss/threads/guidance-on-the-purpose-of-13160.203881/
- 05allzonems.comhttps://www.allzonems.com/wound-repair-coding/
- 06mdclarity.comhttps://www.mdclarity.com/cpt-code/13160
Mira AI Scribe
Mira's AI scribe captures the dehiscence timeline, wound dimensions in centimeters, tissue viability findings, debridement technique, extent of undermining, and each layer of closure from dictation. This prevents the most common 13160 audit flag: an operative note that documents layered closure without the complexity elements that distinguish secondary closure from a simple repair.
See how Mira captures CPT 13160 documentation