HCFA Establishes Unique Code for Dermabond Use
Published on Sat Jan 01, 2000
For months, coders debated the pros and cons of coding wound repair using the tissue adhesive,
2-cyanoacrylate (Dermabond), manufactured by Ethicon, with the standard CPT repair (closure) codes (12001-13160). The Dermabond/tissue adhesive controversy was resolved by the CPT editorial panel in May 1999 when it clarified that coding for wound repair with tissue adhesives was appropriate for all levels of laceration repair.
Note: The panel specified the use of tissue adhesive exclusively to close a wound would constitute simple repair. And, single-layer, heavily contaminated wounds requiring extensive cleansing and/or removal of particulate matter, constitute intermediate repair. (See the insert and reader question in the May 1999 ED Coding Alert.)
The repair (closure) code information in the integumentary system section of CPT 1999, pages 57-58, did not specify suturing as a qualification for use of a wound repair code. Only closure with adhesive strips was singled out for special coding treatment, and that was to specify that a wound repair service with this as the sole closure material should be included in the overall evaluation and management (E/M) code. Nowhere in the general instructions for use of the repair (closure) codes were any other forms of wound closure addressed. Thus, coders deemed wound closure codes an accurate reporting of wound closure with this new technique.
CPT 2000 Includes Dermabond Use
CPT 2000 provided formal clarification on coding for this product by referencing it directly in the instructions for use of the repair (closure) section. The introduction to this subsection indicates that closure can be achieved with sutures, staples, or tissue adhesives (e.g., 2 cyanoacrylate), either singly or in combination with each other, or in combination with adhesive strips. This clarification seemed to provide the final word and a resolution of the issue of appropriate coding for the use of tissue adhesives.
However, the Nov. 2, 1999, issue of the Federal Register states that the unique Health Care Financing Administration (HCFA) Common Procedure Coding System (HCPCS) code G0168 is to be reported when 2-cyanoacrylate is used. As outlined in the instructions, this code is to be reported when wound closure is achieved solely with the use of tissue adhesive. Wounds closed with tissue adhesives in addition to other materials (staples, sutures, etc.) should be coded with the appropriate CPT code.
According to the administrations reasoning, data provided by the Food and Drug Administration (FDA) indicates that wounds closed with tissue adhesives require only one-quarter of the time necessary to close a wound with traditional methods. The work associated with the use of tissue adhesive was determined to be comparable to a level two E/M service. HCFA then assigned the work component of the relative value unit (RVU) a value of [...]
