Primary Care Coding Alert

With long summer days right around the corner, fitness fanatics long cooped up inside will grab their cobwebbed bicycles, landing your family physician (FP) with treating cuts and pebbly knees. Before you code another simple repair, make sure you're not missing out on reimbursement by undercoding your FP's services and falling into fraudulent billing. One of the biggest mistakes that FP coders make is reporting a simple laceration repair rather than an intermediate repair, says Marie Felger, CPC, a family practice coding consultant and American Academy of Professional Coders (AAPC)-certified coding instructor with Joy Newby & Associates LLC in Indianapolis. It's an error that can cost your practice revenue, not to mention the danger you create by not coding to the highest specificity, Felger warns.

"Physicians often do not give enough information for coders to know whether an intermediate repair was performed," Felger says. In this case, the coder will report a simple repair. To stop incorrectly reporting laceration repair, check the documentation and your skills at selecting the right code. 1. Do Chart Notes Include a Layer Description? When choosing between simple (12001-12021) and intermediate (12031-12057) repair codes, encourage your FP to use specific language. You should report a simple repair when the wound is superficial, says Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc., a healthcare consulting firm based in Landsdale, Pa. Wounds that primarily involve the epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures, require a simple one-layer closure.

"Intermediate repair includes the repair of wounds that, in addition to the work involved in a simple repair, require closure of one or more of the deeper layers of subcutaneous tissue and superficial fascia," Falbo says. Complex repair requires more than layered closure. FPs often fail, however, to mention intermediate repair or how many layers they closed, Falbo says. Doctors should use terms such as "deeper layers of subcutaneous tissue and superficial (nonmuscle) fascia," "layered closure" or "deep layer suturing" to indicate they performed an intermediate repair, she says. For instance, a physician may suture a deep subcutaneous wound, which would require layered closure. If the documentation fails to mention the layered closure, the coder will miss that and report a simple repair code rather than the more accurate and higher-paying intermediate repair code, Felger says. 2. Does Documentation Refer to Debridement? Another area your FP should include in chart notes is the extent of debridement he or she performs. Although intermediate repair usually requires layered closure, single-layer closure of heavily contaminated wounds that require extensive cleaning or removal of particulate matter also constitutes intermediate repair, according to CPT's repair (closure) notes. But many doctors forget to state that they performed decontamination or [...]