ED Coding and Reimbursement Alert

Question: My ED physician performed a complex repair of a lacerated left ring finger. After performing a level-three E/M, the physician documented that there were two lacerations. One was a 6 cm cut with partial-thickness skin loss and a severed digital artery. The other was a 10 cm V-shaped laceration on the left index finger extending down to the tendon sheath with partial-thickness skin loss. The physician spent more than an hour repairing these two lacerations. My thought was to use 13132 with +13133. How do I code both lacerations? Also, what modifier I should use?

Michigan Subscriber

Answer: Your description indicates that the physician performed two complex repairs in the same anatomical location. Once you are absolutely sure that is true, report the following:

• 13132 (Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm) for the first 7.5 cm of repair

• +13133 (... each additional 5 cm or less [List separately in addition to code for primary procedure]) x 2 for the remaining 8.5 cm of repair

• 99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity ...) for the E/M

• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99283 to show that the E/M and laceration repairs were separate services.

CPT instructs coders to add the length of repairs in the same anatomical area and of the same classification. The coding advice above accounts for all 16 cm of laceration repair.