# what code would i use?



## debraj (Nov 11, 2011)

Patient, a 42-year old construction worker, is injured at work when a box containing wood scraps and shingles falls from a second story scaffolding and strikes him on the left forearm, causing multiple lacerations. Forearm repairs: a 5.1-cm repair of the subcutaneous tissues and a 5.6cm laceration, with particles of shingles and wood materials deeply embedded, both requiring intermediate closure. There is also a superficial wound on the scalp of 3.1cm that requires simple closure.

Can you help with CPT & ICD-9?


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## TonyaMichelle (Nov 11, 2011)

*what codes would i use?*

884.0 ( Multiple and unspecified open wounds of upper limb without mention of complication)
873.0 ( Open wound of scalp without mention of complication)
E916 (Struck accidentally by falling object)
E849.3 ( Injury occurred at work)
E000.9 (Unspecified external cause status)

12034 (intermediate repair of extremities except hands or feet, 7.6 - 12.5cm)                                                                        12002 ( Simple repair of superficial wounds, scalp and extremities, 2.6 - 7.5cm)                                                                     When multiple wounds are repaired in the same classification and grouped in the same code descriptors, add the centimeters.

Hope this helps...


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## debraj (Nov 11, 2011)

it makes sense now! thanks a bunch!


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## mitchellde (Nov 12, 2011)

TonyaMichelle said:


> 884.0 ( Multiple and unspecified open wounds of upper limb without mention of complication)
> 873.0 ( Open wound of scalp without mention of complication)
> E916 (Struck accidentally by falling object)
> E849.3 ( Injury occurred at work)
> ...



I am in disagreement with the CPT codes you selected. First, without the op note it is really hard to tell exactly what would be selected.  However based on what is stated, there are 2 wounds on the forearm one is 5.1 and the other 5.6 cm. The 5.1 was repaired with a layered repair. And the 5.6 had particles removed then repaired.  The repair in inclusive with the exploration on this code.  Then the scalp wound was 3.1cm with a simple repair.  According to the post this was the only simple repair.  So what is stated is 
One foreign body removal with closure
One intermediate repair 5.1cm
One simple repair 3.1 cm
While it is true you add lengths together for repairs of the same kind in the same area you have nothing to add in this scenario.


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## TonyaMichelle (Nov 12, 2011)

*What code would I use?*

I edited my CPT codes for the centimeters, 2 intermediates and 1 simple repair and 25248 is inclusive. Thanks for bringing that to my attention.


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## mitchellde (Nov 12, 2011)

but there is only one intermediate repair, if you are going to use the code for the removal of the foreign body the wound closure is inclusive to the wound treatment.
So you have one wound exploration, one intermediate repair and one simple repair.
the simple repair is 3.1 cm which is 12002 the intermediate is 5.1cm 12032 and the exploration I agree with.


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## TonyaMichelle (Nov 14, 2011)

*What code would I use?*

In his report it states," Forearm repair of a 5.1 cm repair subcutaneous tissue and a 5.6cm laceration with particles of shingles and wood materials deeply embedded, BOTH REQUIRING INTERMEDIATE CLOSURE". So from that, I am seeing 2 separate intermediate skin closures with centimeters to be added together in order to get one cpt code in the intermediate skin closure category which is 12034. The scalp is by itself in the simple skin closure 3.1cm. 12002.

And the removal of foreign body would be inclusive because under the heading "Repair (Closure)" Definitions: Intermediate repair includes the repair of wounds that , in addition to the above, require layered closure of one of more of the deep layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition to the skin ( epidermal and dermal closure. Single-layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair. 

If am I wrong. I really welcome any feedback. Thanks.


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## mitchellde (Nov 14, 2011)

Tonya this is where we can only speculate without the actual operative note you might be right Or I might be right, but if the removal of the foreign body is in fact extensive then the wound needed exploration the I would go with that code then the closure for that wound is inclusive.  Either could be correct.


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## TonyaMichelle (Nov 14, 2011)

*What code would I use?*

Ok, thankyou...


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