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ED Coding and Reimbursement Alert

You Be the Coder:

Repair Coding and Mouth Injuries

Published on Mon Apr 20, 2009

Question: A patient with a laceration on the inside of her mouth reports to the ED; the wound is bleeding, but a level-two E/M reveals that the cut is entirely inside the patient's mouth. The nurse practitioner (NP) stops the bleeding with gauze and some light pressure. Then the ED physician closes the 2.3-cm cut using sutures. We reported 12011 and our internal compliance office questioned the code. Why? Minnesota Subscriber Answer: This is an example where you can measure the coding in degrees of accuracy. While the mucous membrane repair descriptor is not fully incorrect, there is a more specific code for the service. A better choice for this encounter would be one of the vestibule of mouth repair codes (40830-40845). When you re-submit the claim, report the following: - 40830 (Closure of laceration, vestibule of mouth; 2.5 cm or less) for the repair - 99282 (Emergency department visit [...]
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