CODING CORNER: Stitch Up Your Laceration Coding WithThese 4 Cardinal Rules

Experts reveal the truth about when it's OK toreport intermediate repair codes
If you resort to simple repair codes (12001-12021) when you could easily - and more accurately - report intermediate services (12031-12057), you may be losing major reimbursement and not even know it.
You can get the laceration repair payment you deserve by knowing the right time to report higher-paying intermediate laceration repairs. Use these four expert coding recommendations to get your repairs started.
1. Look for Layer Descriptions
When choosing between simple (12001-12021) and intermediate(12031-12057) repair codes, encourage the physician to use specific language. This way, you can more easily select the appropriate code, says Catherine Brink, CMM, CPC, president of HealthCare Resource Manage-ment Inc. in Spring Lake, N.J.
For example: If the physician documented a 2.2-cm superficial wound that primarily involved the epidermis, dermis or subcutaneous tissues without significant involvement of deeper structures, he probably performed a simple one-layer closure. In this case, you would report 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less).
On the other hand, if the physician performs an intermediate repair, he treats wounds that not only include the simple repair services but also require layered closure of one or more deeper layers of subcutaneous tissue and superficial fascia, Brink says.
Hint: Look for the key phrase "layered closure." Other terms that may signal an intermediate repair: "deeper layers of subcutaneous and superficial (nonmuscular) fascia," "layered closure," and "deep layer suturing."
2. Get Down and Dirty to Raise Complexity
Although intermediate repair usually requires layered closure, you can often report intermediate codes when the physician performs a single-layer closure of heavily contaminated, or "dirty," wounds. According to CPT guidelines, extensive debridement or cleaning of wounds as part of a repair qualifies the service as intermediate.
Example: A patient presents with a 2.7-cm gash on his right knee and shin. The cut contains a lot of gravel and debris. The physician thoroughly cleans the wound before performing a single-layer repair. If she documents "Sutured 2.7-cm wound, knee/shin" and fails to include "extensive debridement," you'd report 12002 (... 2.6 cm to 7.5 cm) instead of 12032 (Layer closure of wounds of scalp, axillae, trunk, and/or extremities [excluding hands and feet], 2.6 cm to 7.5 cm).
3. Know the Multiple-Laceration Formula
Ratchet up your coding skills: You may have mastered how to identify intermediate repairs, but you may still have to categorize multiple lacerations.
To report laceration services effectively and receive proper reimbursement, you must know how to bill all of the services the [...]

- Published on 2005-01-01