ED Coding and Reimbursement Alert

Question: When there is a simple laceration and a small foreign body is removed, should the wound exploration code be used, or is that only for the operating room?

Florida Subscriber

Answer: The wound exploration codes (20100-20103) may be used if a wound requires enlargement, extension or dissection to determine penetration, or allow debridement, removal of foreign bodies, ligation or coagulation of minor vessels of the subcutaneous tissues, muscle fascia and/or muscle (not requiring thoracotomy or laparotomy). If the simple laceration required extensive cleaning or removal of particulate matter, it may be considered an intermediate repair under CPT guidelines, instead of a simple repair. The physician must have sufficient documentation to support the codes he or she is billing. If the physician does not have sufficient documentation describing the amount and size of the foreign body removed and method of removal, only a simple repair code can be reported.