ED Coding and Reimbursement Alert

Question: I am having difficulty determining whether this physician's note documents an artery repair or simply a layered closure:

"There did appear to be one superficial arterial bleeder present that was ligated with a figure-of-eight  stitch with #4-0 vicryl. Two sutures were required for this. The skin was closed with #4-0 nylon, and three sutures were placed." Which code should I use?
      
Washington Subscriber

Answer: While this documentation states that the physician closed both the artery and the skin, unfortunately you can't report an artery repair in addition to the skin repair (closure).
 
CPT doesn't recognize the extra work involved in ligation of the arterial bleeder, so that service is bundled into the closure codes. In the guidelines for wound repair, CPT specifically states that simple ligation of vessels in open wounds is considered part of any wound closure. Instead, report the appropriate simple, intermediate, or complex closure code from the 12000 or 13000 series, depending on the physician's documentation.
 
Based on this documentation, you would not report a layered closure. Because the artery is considered superficial and its repair is bundled into the wound closure code - and layered closure was not otherwise indicated - just report the regular closure code from the 12001-13160 series.