Pediatric Coding Alert

Are you having trouble piecing together the information you need to report laceration repairs accurately? Its not that difficult that is, if you know what to document.
 
Coding experts offer the following six tips that will help you sew up any holes in your laceration repair billing and improve your reimbursement.
 
1. Determine the Method of Closure Your first step is to identify the method(s) used to close the wound. For repairs with sutures, staples or tissue adhesive (Dermabond), either singly or in combination with each other, you would report a code in the 12001-13160 range, according to CPTs introduction to laceration repair. 
  If the pediatrician uses adhesive strips (Steri-strips) as the sole repair material, you would not code this as a laceration repair, CPT says. Regardless of the classification, size or site of the wound, if applying a Steri-strip is the only repair, bill only an E/M code (99211-99215), not a repair code, says Susan Callaway, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C.
 
Expect the E/M service for Steri-strip application to be at a low level, Callaway adds.
 
For example, a 5-year-old girl falls on a playground and cuts her leg. The pediatrician determines that the wound does not warrant stitches, staples or tissue adhesive and instead closes the laceration with Steri-strips or a butterfly bandage. In this instance, you would report CPT 99213 or higher, depending on how much time the physician spent evaluating the trauma and repairing the wound.
 
2. Check Notes for Wound Severity Next, youll need to determine whether the repair is simple, intermediate or complex based on the procedure documentation.
 
Physicians should prepare a separate laceration repair note, apart from any E/M documentation, that describes the laceration, any debridement required, the number of layers repaired, and the repaired length, says Jeffrey Linzer Sr., MD, MICP, FAAP, assistant professor of pediatrics at Emory University and EMS coordinator at Childrens Healthcare of Atlanta and Hughes Spalding Childrens Hospital.
 
Use a code in the simple repair range (12001-12021) when the pediatrician documents that the wound is superficial, involving primarily the epidermis or dermis or subcutaneous tissues and requires a single-layer closure, CPT states.
 
For intermediate repairs, report a code in the 12031-12057 range when the physician indicates that the laceration required closure of one or more deep layers of subcutaneous tissue, in addition to the epidermal/dermal closure, according to CPT. 
 
Complex repairs (13100-13160), which are not likely in an ambulatory pediatric practice, involve complicated, multiple-layered closures and are often reconstructive procedures. These closures generally involve muscle or tendon repair, and a sub-specialist usually performs them, Linzer says. Avoid Undercoding Intermediate Repairs Dont make the mistake of reporting a simple repair code when the pediatrician actually [...]