ED Coding and Reimbursement Alert

Question: A patient reports to the emergency department (ED) with two wounds on their trunk. Encounter notes indicate a wound on the abdomen measuring 8.5 cm and another wound on the chest measuring 2.9 cm. The ED physician uses lidocaine to prep the surgical areas. They then perform single-layer closure on the chest wound using absorbable sutures. Finally, the physician performs closure of the abdominal wound with surgical staples; the abdominal closure involved the epidermis and extended into the subcutaneous tissue and non-muscle fascia.

How should I report this encounter? Can I use separate codes for the lidocaine or any of the surgical supplies?

AAPC Forum Participant

Answer: No, you cannot report separate codes for the lidocaine or any surgical supplies; it’s all included in the surgical packages for the two wound repairs. You will, however, be able to report a pair of CPT^® codes for this encounter.

On the claim, report the following:

• 12034 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm) for the abdominal repair
• 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 the chest repair
• Modifier 51 (Multiple procedures) appended to 12002 to show that the ED physician performed multiple procedures during the encounter — if the payer requires it

Complexity reminder: When the ED physician repairs a wound with a single-layer closure involving only the epidermis or dermis, you’ll almost always opt for a simple repair code. Some exceptions include wounds that require extensive cleaning or wounds with particulate matter. Since you didn’t note any extra cleaning, etc., in your description, you’ll go with the simple repair code for the chest wound.

Most intermediate wound repairs involve more than just the top layer of skin, reaching into the deeper subcutaneous tissues and even into non-muscle fascia. Since you did note these features in your description, you’ll go with the intermediate repair code for the trunk wound.

Chris Boucher, MS, CPC, Senior Development Editor, AAPC