Keep Wound Repair Coding Simple
by Sheri Poe Bernard, CPC, CPC-H, CPC-P
CPT® and ICD-9-CM code selection for lacerations and their repair is a simple task if you break down coding criteria into simple components.
Length, Location, and Type
For CPT®, integumentary repair codes specify length, location and type of wound repair. Codes are selected by:
Laceration length in centimeters rounded to the nearest tenth of a centimeter. The difference in reimbursement between an intermediate repair of 20 cm and one of 20.1 cm is $60. Don’t round numbers down.
Laceration location, for example, genitalia; eyelid, foot, scalp. The difference in reimbursement between a 10 cm simple repair to the neck and a 10 cm simple repair to the face is $50.
Type of wound repair as simple; intermediate; or complex. Reimbursement for a 10 cm wound to the foot is $140 (simple); $225 (intermediate); or $450 (complex).
ICD-9-CM Is Another Language
ICD-9-CM language does not mirror the language of CPT®. Even so, ICD-9-CM codes must support medical necessity for wound repair.
In ICD-9-CM, a complicated wound has a foreign body, infection, or delayed treatment or healing. Contamination requiring debridement also qualifies as complicated. A complicated wound diagnosis helps support the medical necessity of an intermediate or complex repair.
The location of the wound is much more detailed in ICD-9-CM, where, for example, a wound to the face is specified as cheek, forehead, lip, or jaw. Involvement of tendons can also be reported with open wound codes, however, injuries to blood vessels or nerves are separately reported in ICD-9-CM.
Adding-up the Documentation
CPT® guidelines require repairs of similar complexity and location to be grouped for reporting. Three intermediate repairs to the feet, measuring 12.3 cm, 5.7 cm, and 6.8 cm should be added to report one intermediate repair of 24.8 cm (12046 Layer closure of wounds of neck, hands, feet and/or external genitalia; 20.1 cm to 30.0 cm).
If the wound was successfully closed using only adhesive strips, no “repair” was performed, and the encounter would be reported using an E/M code. Similarly, consider the patient who present with multiple complaints. In addition to suturing a head wound, the physician evaluates the patient for head trauma. This qualifies as a separate E/M service reported with modifier 25 Significant, separately identifiable E/M service. Also capture with codes any tests or inoculations (tetanus) found in the record.
If extensive debridement is required, it can be reported in addition to the repair using codes from the 11040-11044 series.
Select the best code to reflect the work performed. Although CPT® codes for repair include external genitalia, CPT® provides specific codes for some scenarios. For example, 57200 Colporrhaphy, suture of injury of vagina (nonobstetrical) reports an external genitalia repair. Which code should you use? In some cases, 57200 pays more than an integumentary code, but if the wound is complex or large, the integumentary code may pay more than 57200. Be alert to RVUs as you code.
Know the Follow-up Rules
Laceration repairs have a global period of zero to 10 days. Know which codes have a 10-day rule and understand that follow-up care within the global period cannot be billed. Follow-up care includes dressing changes, incision care, suture removal, and wound cleansing. According to CPT® guidelines, infections, wound dehiscence, complications or new conditions can be separately reported.
- Therapists Gain More Freedom in New Waiver - May 22, 2020
- Message From Your Region 6 Representatives | Pam Tienter and Jean Pryor - January 16, 2020
- Message From Your Region 3 Representatives | Astara Crews and Dianne Estes - January 16, 2020