ED Coding and Reimbursement Alert

Question: Encounter notes indicate that the ED physician treated two wounds to a patient’s face: a 4.2 cm simple wound and a 2.0 cm intermediate wound. Should I add up the repair lengths and choose a procedure code based on that number?

Alaska Subscriber

Answer: No, you should not add the repair lengths for this encounter because even though the repairs were in the same anatomical area, they were not of the same severity.

Instead, you will report:

• 12051 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less) for the intermediate repair
• 12013(Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm) for the simple repair
• Modifier 51 (Multiple procedures) appended to 12013 to show that you are coding for multiple procedures.