Otolaryngology Coding Alert

Question: We saw a patient at the hospital who was in a motor vehicle accident (MVA). Our otolaryngologist closed a facial laceration and a major ear laceration, in which the ear was cut in half down deep. The surgeon cleaned out gas and paint chips from the ear laceration. He then closed the sections in layers. How should I code the ear procedures?

Georgia Subscriber Answer: You should report the closure and cleaning of the ear laceration with the appropriate complex repair code. -Complex repair includes the repair of wounds requiring more than layered closure, viz., scar revision, debridement (e.g., traumatic lacerations or avulsions), extensive undermining, stents or retention sutures,- according to CPT's repair (closure) introductory notes.

Error averted: Do not separately code the cleansing. -Debridement is considered a separate procedure only when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately without primary closure,- the AMA explains in its wound repair instructions (#3).

Choose the appropriate repair code for the ear laceration based on anatomic site, the wound's depth, and the repair's size. A laceration that cut the ear in half could be 13152 (Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm).

Don't forget: Use a separate repair code for the facial laceration based on anatomic site, the wound's depth, and the repair's size. CPT stipulates that you should not add together lengths of wounds from different anatomic sites.

Remember to use modifier 51 (Multiple procedures) on the less complicated procedure -- the facial laceration. Example: For a 4-cm complex closure of the ear and a layered closure of a 2.6-cm facial laceration, use 13152 and append modifier 51 to 12052 (Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm).