ED Coding and Reimbursement Alert

Determine how you would code these laceration repairs If you're still unsure about how to report laceration services, fine-tune your coding knowledge before you submit that next laceration claim. Write either "true" or "false" in the blank next to the questions, then check your answers against those of the coding experts. 1. The emergency department (ED) physician repairs a 4.4-cm superficial wound on a patient's chest and a 6.2-cm simple laceration on the patient's neck. He classifies the wounds in the same class and in the same anatomic site. You should add the measurements as 4.4 cm + 6.2 cm = 10.6 cm and report 12004 (Simple repair of superficial wounds ...; 7.6 cm to 12.5 cm). _________  
 
2. The physician treats a 2.1-cm cut that he describes as a superficial wound that primarily involves the epidermis or dermis, so you should report 12031 (Layer closure of wounds ...; 2.5 cm or less). __________
 
3. The physician performs an intermediate repair. He should include terms such as "layered closure," "deep layer suturing" or "extensive debridement" in the chart notes. ____________
 
4. CPT lumps all laceration codes into the same body groupings or class. ___________ Check Your Work
 
1. True. Always pay attention to CPT body groupings because they change based on the repair's class. In the question, you would use 12004 because the physician performed repairs in the same class (simple) and in the same anatomic site.
 
2. False. The proper code is 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less). Look for descriptions such as "superficial" and "primarily involves epidermis or dermis" when you report simple repair codes.
 
3. True. Intermediate laceration services include layered closures, deep layer suturing and extensive debridement, so make sure to document these carefully.
 
4. False. CPT puts laceration services into three classes: simple, intermediate and complex. Also, CPT classifies lacerations into different body groupings. For example, CPT includes hands, feet and/or extremities in the same anatomic site for simple repairs (12001-12007). The intermediate repairs codes for extremities (12031-12037) exclude hands and feet.