ED Coding and Reimbursement Alert

Question: A patient who fell off a four-wheeler (all-terrain vehicle) while driving reports to the ED with lacerations to her face, arms, and legs. After a level-four E/M, the ED physician performs layered closure on a 3 cm face laceration. Then, she performs a single layer repair of a 5 cm laceration of the left thigh, a 3 cm laceration of the right forearm, and a 7 cm laceration of the left calf/ankle. She then directs the patient to see her internist for any follow-up care. What is the proper coding for this scenario? Should I submit a procedure code for each of the repairs? Illinois Subscriber Answer: You-ll code the face laceration fix as an intermediate repair, and then add the lengths of the remaining repairs and choose one code. On the claim, report the following: Face repair: - 12052 (Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm) for the face repair - 873.40 (Other open wound of head; face, without mention of complication; face, unspecified site) appended to 12052 to represent the patient's facial injury - E821.0 (Nontraffic accident involving other off-road motor vehicle; driver of motor vehicle other than motorcycle) appended to 12052 to represent the cause of the injury. Other repairs: - 12005 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 12.6 cm to 20.0 cm) for the thigh (5 cm), forearm (3 cm), and lower leg (7 cm) repairs (since these repairs were of the same complexity and in the same anatomic site, you should add them together and choose a single code) - 881.00 (Open wound of elbow, forearm, and wrist; forearm, without mention of complication), 890.0 (Open wound of hip and thigh; without mention of complication), and 891.0 (Open wound of knee, leg [except thigh], and ankle; without mention of complication) appended to 12005 to represent the patient's other cuts. - E821.0 appended to 12005 to represent the cause of the injury. E/M: - 99284 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: a detailed history; a detailed 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 99284 to show that the E/M and repairs were separate services. - 873.40, 881.00, 890.00, 891.00, and E821.4 appended to 99284 to represent the patient's injuries, and their cause.