Proper Coding for Tissue Adhesives
Tissue adhesives, such as Dermabond®, may be used alone or in combination with other methods (e.g., sutures or staples) for laceration repair or to close surgical wounds. The adhesive is applied directly to the skin or tissue of an open wound to hold the margins closed for healing. Proper coding for tissue adhesives has changed over time, and also depends on the insurer.
CPT® directs you to report Repair (Closure) codes 12001-13160, as appropriate to the type (simple, intermediate, or complex), location, and length of the wound “to designate wound closure utilizing sutures, staples or tissue adhesives (eg, 2-cyanoacrylate), either singly or in combination with each other, or in combination with adhesive strips.”
Private, third-party payers generally follow CPT® guidelines and allow you to report 12001-13160 for tissue adhesives, whether used alone or with other closure methods. Medicare payers will recognize the wound repair codes as long as tissue adhesive is used in combination with sutures or staples. However, If the provider uses only tissue adhesive to close the wound, you must report G0168 Wound closure utilizing tissue adhesive(s) only for Medicare payers. Code G0168 is an active code (status “A”) and eligible for Medicare payment under the National Physician Fee Scheduled Relative Value File.
For example, if the physician performs a simple repair of a 5 cm laceration on the upper chest using Dermabond® with sutures, correct coding is 12002 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cm for private payers and Medicare. If the provider closed the wound using Dermabond® only (no sutures or staples), you may report 12002 for private payers, but you must report G0168 for Medicare.
Per CPT® and Medicare instruction, if closure is achieved using Steri-strips or bandages only, you may not report wound repair codes or G0168. Instead, you should report wounds closed with Steri-strips or bandages with the appropriate evaluation and management code.
Latest posts by John Verhovshek (see all)
- When to Use Modifier SA - July 24, 2017
- Diagnostic Coding for Type 2 Myocardial Infarction - July 24, 2017
- CMS Wants to Revise E/M Documentation Guidelines - July 14, 2017