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E/M visit/Wound Repair

kimb

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Can you charge a 99213 with a wound repair 12001 if the only diagnosis is for the laceration. Your help would be appreciated
 

mbort

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ENGLEWOOD/DENVER
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yes if the documentation supports the 99213 E/M, you would add the 25 modifier on the E/M (since there is only a 10 day global on the 12001). However if this was a planned follow up visit and closure of this laceration was planned, then you would only be able to capture the 12001.

Hope this helps
Mary
 

goldejoa

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Can someone help me find where the 10 day global period is defined? There is alot of discussion amongst the office about 10-14 days for certain procedures and less than 10 days for others ( ie: wounds of the face where the physician states return in 5 days for removal). I am under the impression that 10 days is 10 days and that if the patient returns to the ED, ( I code for the ED) where we placed the sutures, before the 11th day that it is a no charge visit and is included in the global. Someone please correct me if I am wrong and point me in the right direction!

Thanks
 

jas0426

Networker
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64
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NCF Gainesville
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I think that the patient returns sooner for certain areas simply because of the area the wound is in, not based on the global period. The global period for the CPT code is the same regardless of where it is. I know that sutures in different areas though, do stay in different amounts of time. You are correct about the no charge visit. The only time you can charge for a suture removal, is if you were not the provider that did the repair.
 

schacko

Networker
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37
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Hey...

If the only diagnosis is laceration and the only procedure done is suturing...then would suggest to code 12001 only....E/M may be assigned along with 12001 with a mod-25...if an additional diagnosis have been addressed or an additional workup (Xray or labs) is performed...
This indicates E/M covers the additional services done and 12001 covers the services performed for laceration only.

Hope this helps..
 

dmaec

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1,133
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Hibbing, Minnesota
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kimb, (in my opinion) If the sole purpose of the visit was for laceration repair - then that's all I would code. If the provider had to do a "more than usual" to assess the laceration (often they do more with head lacerations - more of a neuro/extremity type of exam depending on the situation), then coding the procedure and E/M with a .25 modifier on it is fine. However, keep in mind they always have to assess the laceration, check it out - decide what/how to close it IF they're closing it, etc. that's expected and that's all included in the laceration repair code. It's only when it goes above and beyond what's normally required that you can code and E/M with that. It doesn't have a to be a different dx code, it can be the same. Let me add, usually - with "simple" repair of anything, an E/M level isn't justified. Again, I say "usually", (sometimes it is, like with head injuries/lacerations).
 

dmaec

True Blue
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Location
Hibbing, Minnesota
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Can someone help me find where the 10 day global period is defined? There is alot of discussion amongst the office about 10-14 days for certain procedures and less than 10 days for others ( ie: wounds of the face where the physician states return in 5 days for removal). I am under the impression that 10 days is 10 days and that if the patient returns to the ED, ( I code for the ED) where we placed the sutures, before the 11th day that it is a no charge visit and is included in the global. Someone please correct me if I am wrong and point me in the right direction!

Thanks
hi goldejoa: here is a link for the physician fee schedule - it has a lot of very useful informatin on it including global days. http://www.cms.hhs.gov/PhysicianFee...=ascending&itemID=CMS1209430&intNumPerPage=10
you'll have to download it.

Often, they take sutures out of the face at five days because if they leave them in longer they tend to leave more of a scar. (our face heals differently than our arms/legs/etc). It's still within the global. Sometimes the providers want/need to leave the stitches in a little longer (14 days), due to some reason. In those cases, our providers still do not charge a visit for taking them out a few days past the 10 day global. Not if it's the ONLY reason they're coming back in, and especially not if the provider made the decision to leave them in a bit longer! But that's just our policy, per guidelines, you can charge if it's past the global days.
 

goldejoa

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Thanks for your help! I think I have been on the right track, but wanted some input, so your help is greatly appreciated!

Joan G
 
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