ED Coding and Reimbursement Alert

These 3 rules can save you $50 per cut Reimbursement for laceration repairs could be slipping away if you're resorting to simple repair codes (12001-12021) when you could -- more accurately -- report intermediate repairs (12301-12057). Keep these three expert recommendations in mind when identifying whether you've earned intermediate repair pay. 1. Uncover Layer Descriptions You need solid physician documentation to choose between simple (12001-12021) and intermediate (12031-12057) repair codes -- so encourage the emergency department (ED) physicians to use specific language to describe their services. You'll have an easier time selecting the appropriate code this way, says Catherine Brink, CMM, CPC, president of HealthCare Resource Management Inc. in Spring Lake, N.J.

For example, if the physician documented a 2.2-cm superficial wound on the forearm that primarily involved the epidermis, dermis or subcutaneous tissues without significant involvement of deeper structures, she probably performed a simple one-layer closure. In this case, you would report 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less).

On the other hand, if your physician performs an intermediate repair, she treats wounds that include the simple repair services but also require layered closure of one or more deeper layers of subcutaneous tissue and superficial fascia, Brink says.

Hint: Look for key phrases that signal that the physician performed an intermediate repair. In the above example, the phrase "layered closure" should give away which code to choose. Other terms that may alert you to an intermediate repair include "deeper layers of subcutaneous and superficial (nonmuscular) fascia" or "deep layer suturing," so keep your eyes peeled for these cues. 2. Clean Up Complexity Although intermediate repair usually requires layered closure, you can sometimes report intermediate codes when the ED physician performs a single-layer closure of heavily contaminated -- or "dirty" -- wounds. According to CPT, single-layer closures involving extensive "cleaning or removal of particulate matter" constitute intermediate repair, says Michael A. Granovsky, MD, CPC, FACEP, vice president of coding at MRSI in Stoneham, Mass. 

Your physician may forget to include the cleaning detail when documenting laceration services. Explain that omitting these details could easily cost the practice $50 per repair.

Example: After a skating accident, a patient presents with a 2.7-cm gash on his right knee. Because the accident occurred on a gravelly road, the cut contains a lot of gravel and debris. The ED physician spends a considerable amount of time cleaning the wound to remove the gravel before performing a single-layer repair.

If she documents "sutured 2.7-cm wound, knee" but not "extensive cleaning or removal of particulate matter," you'd have to report 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [...]