Medicare Compliance & Reimbursement

Question: An established patient reported to our practice with a cut in the vestibule of the mouth; it was bleeding moderately. The patient reported that he bit down on a lobster shell by mistake and cut the roof of his mouth. After stopping the bleeding, the physician irrigated the area to ensure there was no debris. Then, she used sutures to close a 2.2 cm wound. Notes indicated a levelthree E/M preceded the repair. I reported 40831 and received a denial. What happened? Answer: The claim didn't fly because the wound was not long or complicated enough to justify your code choice. When you resubmit the claim to your payer, report the following codes: • 40830 (Closure of laceration; vestibule of mouth; 2.5 cm or less) for the mouth repair • 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least [...]