ED Coding and Reimbursement Alert

Question: A patient reports to the ED after suffering a dog bite on her right forearm; The ED physician performs a level-two E/M service, and then fixes the wound with a 2.8 cm repair using surgical staples. The wound depth extended "to the subcutaneous tissue," according to notes. Is this an open or closed wound, and which CPT code should I choose for this encounter?

Michigan Subscriber

Answer: Since the patient's skin was broken, this is an open wound. On the claim, report the following:

• 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet; 2.6 cm to 7.5 cm]) for the wound repair
• 99282 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity ...) for the E/M service
• modifier 25 (Significant, separately identifiable evaluation and management service on the by the same physician on the same day of the procedure or other service) appended to 99282 to show that the E/ M and wound repair were separate services
• 881.00 (Open wound of elbow forearm and wrist; forearm; without mention of complication) appended to 12002 and 99282 to represent the patient's injury
• E906.0 (Other injury caused by animals; dog bite) appended to 12002 and 99282 to represent the cause of the patient's injury.

Common causes: An open wound occurs when the skin is cut, torn, or punctured. In addition to animal bites, these injuries can often prompt open wound presentations:

• avulsions
• cuts and lacerations
• puncture wounds
• gunshot wounds
• traumatic amputation.