ED Coding and Reimbursement Alert

Medicare has a special requirement for tissue adhesive Several variables govern coding for wound repair and -- especially for wounds of different severity and location -- selecting the appropriate codes and modifiers can prove daunting. By tackling these procedures with a step-by-step, one-at-a-time approach, however, you can greatly simplify even the most confusing scenarios. Step 1: How Was It Closed? Initially, you must determine if the wound repair/closure codes apply.

According to CPT, codes 12001-13160 -designate closure utilizing sutures, staples or tissue adhesive (e.g., 2-cyanoacrylate), either singly or in combination with each other, or in combination with adhesive strips- [emphasis added].

In other words: Under CPT guidelines, if the physician applies any tissue adhesive or places a single stitch or staple, the wound care codes are appropriate.CPT does not differentiate among stitches, staples and tissue adhesive, and the coding does not change regardless of the physician's method of closure.

Medicare designates special codes for tissue adhesive only: If the physician only uses liquid skin adhesive (Dermabond) to close a wound, however, you should report G0168 (Wound closure utilizing tissue adhesive[s] only) for Medicare payers.

If the physician uses sutures or staples with Dermabond to perform a laceration repair, you can report only the layered laceration repair code based on the length and site of the wound, and you should not report G0168.

Adhesive strips alone don't qualify for wound repair: If the physician closes the wound using adhesive strips only, you may not report the repair/closure codes. Instead, you would report wound closure using adhesive strips as the sole repair material as a part of any E/M service the physician provides.

Example: The physician attends to a child who has sustained a laceration after falling from a swing. She examines the child, cleans the wound and places five stitches. In this case, the repair/closure codes are appropriate.

If the doctor determines that the severity of the laceration does not warrant stitches, staples or tissue adhesive, and instead closes the wound using Steri-strips or butterfly bandages, however, you may report only the appropriate E/M service code, as supported  by documentation. Step 2: Consider Wound Severity After you-ve determined that the wound repair/closure codes apply, you must assess the severity of the wound itself.

CPT classifies repairs as simple, intermediate or complex, according to wound depth, with each category receiving its own complement of codes.

- Simple repairs involve superficial wounds that involve -primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures,- according to CPT. Additionally, CPT stresses -only simple, one layer, primary suturing is required.-  Physicians will refer to these as single-layer closures.  CPT code range 12001-12021 covers such repairs, which include local anesthesia and chemical or electro-cauterization of wounds left unclosed.

- Intermediate repairs [...]