ED Coding and Reimbursement Alert

Question: We recently repaired a laceration on the vermillion border of a patient’s lip. The ED physician documented a “through and through laceration.” How do we code the repair?

Codify Subscriber

Answer: Most complex repairs of the lips will involve either a full-thickness or “through and through” style laceration. When the physician documents a “through and through” repair, that means the laceration penetrated two surfaces of a given structure. In the case of a patient’s lip, this means that the laceration penetrates the skin all the way through to the oral mucosa, or vice versa. For this service, you’ll use code 40650 (Repair lip, full thickness; vermilion only).

In the 2004 Vol.4 Qtr.2 issue of the American Hospital Association (AHA) HCPCS Coding Clinic, the AHA states the following in response to a reader question:

• “Report code 40650 for the repair of the lip lacerations since the physician documented this as a through-and through-laceration. This repair involves all the layers of tissue of the lower lip (i.e. mucosa, submucosa, and subcutaneous tissue).”

As you can see, 40650 only references a “full thickness” laceration in the code description, yet the AHA states that the code is eligible for use when the surgeon repairs a through and through laceration. Therefore, you can deduce that a through and through laceration includes a full-thickness laceration. However, these are not interchangeable terms. A full-thickness laceration does not necessarily qualify as a through and through laceration unless it meets the criteria listed in the definition of a through and through laceration.