ED Coding and Reimbursement Alert

Question: A patient reports to the ED bleeding moderately from the scalp. The patient is using a towel to apply pressure to the wound, which he suffered after a noncollision crash on his dirt bike. The nonphysician practitioner (NPP) examines the patient, ligates a small number of blood vessels, and notices a small amount of dirt in the wound, which she irrigates using saline solution. The physician orders local anesthesia and closes a 3.4 cm scalp wound using surgical staples. The physician then instructs the patient to follow up with his primary care physician (PCP) for further treatment. Is this an intermediate or simple repair?

Illinois Subscriber

Answer: This is a simple laceration repair. On the claim, you would report the following:

12002 (Simple repair of superficial wounds of scalp, neck,axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.6 cm to 7.5 cm) for the scalp repair

the appropriate level E/M code (99281-99285) with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on thesame day of the procedure or other service) appended to show that the scalp repair was separate from the E/M.

873.0 (Other open wound of head; scalp, without mention of complication) appended to 12001 and the E/M code to represent the patient's injuries.

E819.2 (Motor vehicle traffic accident of unspecified nature; motorcyclist) appended to 12002 and the E/M code to represent the patient's injuries.

Explanation: The encounter you describe is a simple repair rather than an intermediate one because the NPP's pre-repair work and the local anesthesia are bundled into 12002. If the encounter had included either of the following, you might have chosen 12032 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet; 2.6 cm to 7.5 cm]):

Extensive cleaning of the wound and removal of

particulate matter

layered repair.