Direct closure after undermining

Read an original fictional chart, identify the supported facts, and explain your coding workflow.

Chart gym · Original fictional record

Service date: 2026-09-09 · Office wound repair professional service

Use your code books and write your reasoning before opening the walkthrough. This exercise contains no real patient information.

Procedure context

Synthetic record, September 9, 2026. The surgeon removes a symptomatic benign lesion from the left forearm by ordinary excision. The pre-excision diameter, including necessary margins, is documented as 1.0 cm. The remaining skin defect is 1.0 cm wide at its widest point.

Signed closure report

The surgeon undermines beneath both wound edges for a maximum distance of 2.0 cm from the edge, then directly approximates the original edges. Sutures close the subcutaneous tissue, dermis and skin. The final repair length is 4.0 cm. No adjacent flap is designed, incised or carried into the defect.

Completion note

The surgeon describes the undermining as extensive and the closure as difficult. No graft is harvested or placed, and no separate site is repaired. The wound is dressed, with hemostasis documented and wound-care instructions provided.

Coding worksheet

A draft labels this closure as adjacent tissue transfer because the surgeon wrote “extensive undermining.” Decide whether that family is supported. Use the recorded dimensions, layers and technique in the authorized repair definition before assigning a repair level or deciding whether it is separately reportable.

Your coding worksheet

Identify the actual closure technique and measurements.
Explain why the report does not establish adjacent tissue transfer.
Check the complete repair definition rather than assigning complexity from an adjective.
Check the excision’s repair inclusions before reporting a separate repair.

In your notebook, record the supported facts, your index route, the instructions you checked, and any missing detail that limits your answer.

Compare with the worked explanation

The surgeon undermines the wound edges and then closes them directly. The record supplies a 4.0 cm repair, tissue layers, a 1.0 cm defect width and up to 2.0 cm of undermining.
No adjacent flap is incised and moved into the defect. Direct approximation after undermining does not establish tissue transfer under NCCI.
Extensive undermining may support the complex-repair pathway, but the complete current definition must be met. Neither “difficult” nor “extensive” alone assigns the level.
NCCI includes simple repair in ordinary excision and has further size-dependent rules for benign excision. Use the documented 1.0 cm excision and full repair definition to check the supported combination; this exercise does not supply a final repair code.

Reference sections: H.1–3; E.6

Practice the linked chart questions