Pediatric Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.


Question: One of our pediatricians wants to start using the disposable skin stapler for laceration repair in the office. How do we bill for this supply? Can we bill for it separately in addition to the procedure fee if the procedure is a starred procedure? Is there an HCPCS Codes ? Or should this be included in the fee for the procedure?

-Claudia Wells
Pediatric Associates Inc., Bellevue, Wash.

  Answer: Closure of the wound by suture material (skin glue or staples) are under the same code. Insurance companies strongly believe that the material used is included in the code. Although the staples (or Dermabond) may be more expensive, the decreased time for the procedure, as compared to suturing, should compensate for thisor at least, thats what insurance companies would have you believe. Because the laceration repair is a separate procedure code, you may bill for an evaluation and management (E/M) code if this is appropriate. A typical scenario is a head injury with scalp lacerations, with a neurological exam justifying the E/M code (9921x).

But remember one thing: The widespread policy that suture supplies are included as part of the laceration repair service was established in the days when needle and silk were not costly. Now that Dermabond and staples are more commonly used, many pediatricians believe its time to change this policy. The bottom line is that decreased repair time does not, in fact, compensate you for the cost of these supplies.