ED Coding and Reimbursement Alert

Question: A patient reports to the ED with a cut in the vestibule of the mouth; it is bleeding moderately. The patient reports that he bit down on a lobster shell by mistake and cut the roof of his mouth. After stopping the bleeding, the ED physician irrigates the area to ensure there is no debris. Then, she uses sutures to close a 2.2 cm wound. Notes indicate a level-three E/M preceded the repair. I reported 40831 and received a denial. What happened? California Subscriber Answer: The claim didn't fly because the wound was not long or complicated enough to justify your code choice. When you resubmit the claim, report the following: • 40830 (Closure of laceration; vestibule of mouth; 2.5 cm or less) for the mouth repair • 99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem [...]