ED Coding and Reimbursement Alert

Some deep cuts require only simple closure

Laceration repair coding can get difficult fast: You-ll have to determine the complexity, length, and number of repairs the physician makes before filing. Follow this expert advice on laceration treatment coding, and you-ll be able to cut through any claim confusion.

Almost 7 percent of ED patients receive some form of wound care, says Jim Blakeman, senior vice president at Emergency Groups Office in Arcadia, Calif. -As the most commonly reported surgical procedure in the emergency setting, accurate coding and documentation has a considerable economic impact on the practice,- he says. Make Sure Service Qualifies as Wound Care According to Nancy Reading, RN, CPC, director of educational services for the American Academy of Professional Coders (AAPC), you need to check if the physician's actions constitute wound repair in CPT's eyes. Otherwise, you should report an E/M code for the service instead of a laceration repair code.

CPT definition: Repair codes designate closure utilizing sutures, staples or tissue adhesive, either singly or in combination with each other, or in combination with adhesive strips.

In other words, if your physician applies any tissue adhesive or places a single stitch or staple, you can report the service with wound care codes, Reading says.

Take note: Although you will report wound closure using tissue adhesives such as Dermabond with the CPT procedural code, report repairs using adhesive strips (Steri-strips) as the sole repair material with the appropriate E/M code. Pay Attention to Complexity for Coding Accuracy CPT groups laceration repair codes by anatomic location and complexity. There are repair codes for each anatomic region in the laceration repair section of CPT, but the groupings vary by complexity.

For example, hands, feet, neck and external genitalia are part of the descriptor for simple repairs 12001-12007 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities ...). However, for intermediate repairs, these regions have their own set of codes (12041-12047, Layer closure of wounds of neck, hands, feet and/or external genitalia ...). 

Best bet: Read the descriptors carefully before choosing a code, to make sure you are in the proper anatomic region. Physician Actions, Layers Determine Wound Type After you-re sure the physician performed a CPT-approved laceration repair, focus on wound complexity. CPT requires coders to report repairs according to the three levels of treatment classification: simple, intermediate or complex.

- Simple repairs occur when the laceration is a single layer, with no particulate or contamination, Blakeman says. You will report these encounters with a code from 12001-12021.

Medicare exception: If the physician uses Dermabond as the only closure material on a simple repair, Medicare requires a separate code for the closure, regardless of length, Blakeman says. Suppose your physician [...]