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Dermabond Wound Closure

  1. #1
    Default Dermabond Wound Closure
    Medical Coding Books
    would you code 12011 or bundle the procedure with the E/M?

    16 y/o female brought to ER after altercation at party. Pt states accidentally hit in face causing L brow lac. No LOC, no neck or back pain, no N/V, W/N or other complaints. Pt denies vision change. Her last Td was within 10 years. Consent obtained verbally by RN from parent to treat.

    Review of Systems
    HENT: Positive for headaches.
    Eyes: Negative for blurred vision, double vision and eye pain.
    Cardiovascular: Negative for chest pain.
    Respiratory: Is not experiencing shortness of breath.
    Gastrointestinal: Negative for nausea and vomiting.
    Neurological: Negative for sensory change, focal weakness and loss of consciousness.
    Past Medical History
    Asthma

    Meds:
    OCP's
    Albuterol

    Allergies:
    NKDA

    BP 124/72 | Pulse 68 | Temp 98.3 °F (36.8 °C) | Resp 16 | Wt 49.896 kg (110 lb) | SpO2 100%

    Physical Exam
    Vitals reviewed.
    Constitutional: She is oriented. She appears well-developed and well-nourished. She appears not diaphoretic. No distress.
    HENT:
    Head:
    Pt has 1 cm L brow/lid laceration below eyebrow as indicated on diagram. No active bleeding or visible fat. Slight surrounding ST swelling.
    Eyes: Extraocular motions are normal. Pupils are equal, round, and reactive to light.
    Neck: No spinous process tenderness present.
    Cardiovascular: Normal rate, regular rhythm and normal heart sounds.
    Pulmonary/Chest: Effort normal and breath sounds normal. No respiratory distress. She has no wheezes.
    Abdominal: Bowel sounds are normal. She exhibits no distension. Soft. No tenderness.
    Musculoskeletal: Normal range of motion.
    Neurological: She is alert and oriented. She has normal strength. No cranial nerve deficit. GCS eye subscore is 4. GCS verbal subscore is 5. GCS motor subscore is 6.
    Skin: Skin is warm and dry. No rash noted. She is not diaphoretic.
    Psychiatric: She has a normal mood and affect. Her behavior is normal. Judgment and thought content normal.
    ASSESSMENT:
    16 y/o female s/p L brow laceration during altercation. Police were at seen per patient, did not want to make report
    PLAN:
    Dermabond applied to close wound. Tolerated well. Pt told to monitor for increased pain, swelling, fever, redness, or pus draining from wound and return.
    Rachele Porter, AS, CPC, CPC-H, CEDC
    no weapons formed against me shall prosper

  2. #2
    Default
    Code 12011, but someone correct me if mistaken. I remember I got a hospital bill for a visit to the ER for a cut in finger that required stitches, and the bill included both the E/M code, and the laceration on finger code.Someone correct me if I'm wrong

  3. #3
    Default dermabond
    Quote Originally Posted by racheleporter View Post
    would you code 12011 or bundle the procedure with the E/M?

    16 y/o female brought to ER after altercation at party. Pt states accidentally hit in face causing L brow lac. No LOC, no neck or back pain, no N/V, W/N or other complaints. Pt denies vision change. Her last Td was within 10 years. Consent obtained verbally by RN from parent to treat.

    Review of Systems
    HENT: Positive for headaches.
    Eyes: Negative for blurred vision, double vision and eye pain.
    Cardiovascular: Negative for chest pain.
    Respiratory: Is not experiencing shortness of breath.
    Gastrointestinal: Negative for nausea and vomiting.
    Neurological: Negative for sensory change, focal weakness and loss of consciousness.
    Past Medical History
    Asthma

    Meds:
    OCP's
    Albuterol

    Allergies:
    NKDA

    BP 124/72 | Pulse 68 | Temp 98.3 °F (36.8 °C) | Resp 16 | Wt 49.896 kg (110 lb) | SpO2 100%

    Physical Exam
    Vitals reviewed.
    Constitutional: She is oriented. She appears well-developed and well-nourished. She appears not diaphoretic. No distress.
    HENT:
    Head:
    Pt has 1 cm L brow/lid laceration below eyebrow as indicated on diagram. No active bleeding or visible fat. Slight surrounding ST swelling.
    Eyes: Extraocular motions are normal. Pupils are equal, round, and reactive to light.
    Neck: No spinous process tenderness present.
    Cardiovascular: Normal rate, regular rhythm and normal heart sounds.
    Pulmonary/Chest: Effort normal and breath sounds normal. No respiratory distress. She has no wheezes.
    Abdominal: Bowel sounds are normal. She exhibits no distension. Soft. No tenderness.
    Musculoskeletal: Normal range of motion.
    Neurological: She is alert and oriented. She has normal strength. No cranial nerve deficit. GCS eye subscore is 4. GCS verbal subscore is 5. GCS motor subscore is 6.
    Skin: Skin is warm and dry. No rash noted. She is not diaphoretic.
    Psychiatric: She has a normal mood and affect. Her behavior is normal. Judgment and thought content normal.
    ASSESSMENT:
    16 y/o female s/p L brow laceration during altercation. Police were at seen per patient, did not want to make report
    PLAN:
    Dermabond applied to close wound. Tolerated well. Pt told to monitor for increased pain, swelling, fever, redness, or pus draining from wound and return.
    This is the description of 12011 in 3M
    The physician sutures superficial lacerations of the face, ears, eyelids, nose, lips, and/or mucous membranes. A local anesthetic is injected around the laceration and the wound is cleansed, explored, and often irrigated with a saline solution. The physician performs a simple, one-layer repair of the epidermis, dermis, or subcutaneous tissue with sutures. With multiple wounds of the same complexity and in the same anatomical area, the length of all wounds sutured is summed and reported as one total length. Report 12011 for a total length of 2.5 cm or less; 12013 for 2.6 cm to 5 cm; 12014 for 5.1 cm to 7.5 cm; 12015 for 7.6 cm to 12.5 cm; 12016 for 12.6 cm to 20 cm; 12017 for 20.1 cm to 30 cm; and 12017 if the total length is greater than 30 cm.

    It states sutures and since our facility uses 3M, we do not code dermabond closure. There is a HCPCS code of G0168 (wound closure utilizing tissue adhesive only).
    Having said that,
    I do not code the adhesive wound closure with the 12011, but I know others that do.

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default CPT Guidelines
    2008 CPT Professional Edition, page 58 under REPAIR (Closure) ... first paragraph:
    Use the codes in this section to designate wound closure utilizing sutures, staples, or tissues adhesives ... (emphasis added by FTB)

    I'd use simple repair code plus the appropriate level ER visit (with -25 modifier)

    F Tessa Bartels, CPC, CPC-E/M

  5. #5
    Default
    I agree with F Tessa, code the repair. We also use 3M...but we have always coded repair for dermabond closure. The description that Anna Weaver is referencing is the CDR (Coder Desk Reference) description...not the CPT description. I would always go with the CPT description over the CDR description.

  6. #6
    Default Dermabond
    As I said, I know those who do code this. I choose not too, as our institution considers dermabond part of the E/M. Yes, CPT is the book that should be used, and 3M descriptions are not CPT descriptions. Sorry, I should have pointed that out when I posted the first time.
    Thanks!

  7. Default
    Quote Originally Posted by FTessaBartels View Post
    2008 CPT Professional Edition, page 58 under REPAIR (Closure) ... first paragraph:
    Use the codes in this section to designate wound closure utilizing sutures, staples, or tissues adhesives ... (emphasis added by FTB)

    I'd use simple repair code plus the appropriate level ER visit (with -25 modifier)

    F Tessa Bartels, CPC, CPC-E/M

    I agree~!
    ~Amy, CPC, CPMA, CEMC~
    Auditor/Consultant

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