Pediatric Coding Alert

Experts reveal when to report intermediate repair codes If you resort to simple repair codes (12001-12021) when you could easily - and more accurately - report intermediate services (12301-12057), you may be losing reimbursement and not even know it.
 
You can get the laceration repair coding payment you deserve. You just need to know when to report higher-paying intermediate laceration repairs. To get started, use the following four expert coding recommendations: 1. Look for Layer Descriptions When choosing between simple (12001-12021) and intermediate (12031-12057) repair codes, encourage your pediatrician to use specific language. This way, you can more easily select the appropriate code, says Catherine Brink, CMM, CPC, president of HealthCare Resource Management Inc. in Spring Lake, N.J.
 
For example, if your pediatrician documented a 2.2-cm superficial wound that primarily involved the epidermis, dermis or subcutaneous tissues without significant involvement of deeper structures, he probably performed a simple one-layer closure. In this case, you would report 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less).
 
On the other hand, if your pediatrician performs an intermediate repair, he treats wounds that include the simple repair services but also requires layered closure of one or more deeper layers of subcutaneous tissue and superficial fascia, Brink says.
 
Hint: Look for the key phrase, "layered closure." Other terms that may signal an intermediate repair include "deeper layers of subcutaneous and superficial (nonmuscular) fascia," "layered closure" or "deep layer suturing." 2. Get Down and Dirty to Up Complexity Although intermediate repair usually requires layered closure, you often can report intermediate codes when your pediatrician performs a single-layer closure of heavily contaminated - or "dirty" - wounds. According to CPT guidelines, extensive debridement or cleaning of wounds as part of a repair qualifies the service as intermediate.
 
Your physician may forget to include the cleaning detail when documenting laceration services. Explain to your pediatrician that omitting these details could easily cost him $50 per repair.
 
For example, after a skating accident, a patient presents with a 7.6-cm gash on his right knee and shin. Because the accident occurred on a gravelly road, the cut contains a lot of gravel and debris. Your pediatrician thoroughly cleans the wound before performing a single-layer repair. If she documents "sutured 2.7-cm wound, knee/shin" and fails to include "extensive debridement," you would report 12002 (... 2.6 cm to 7.5 cm). The average fee for 12002 according to the 2004 Physician Fee Schedule is roughly $78. The average fee for 12032 (... 2.6 cm to 7.5 cm), the intermediate repair [...]