ED Coding and Reimbursement Alert

Get up to speed on laceration coding, because most EDs perform many repairs

When a patient reports to the ED for laceration repair, filing the proper claim depends on wound length, complexity and whether or not the physician performed a separate evaluation and management service during the encounter.

Consequences: Laceration coding is not something you want to take lightly in the ED, says Jim Blakeman, senior vice president at Emergency Groups Office in Arcadia, Calif. If you overcode on a laceration claim, denials and suspicious payers are sure to follow. Conversely, undercoding a laceration repair claim will   cut in to your ED's bottom line.
 
-One in 15 ED patients receives some form of wound care,- Blakeman says, making it one of the most commonly reported ED surgical procedures. Follow this expert advice to filing flawless laceration repair encounters in your ED:

Choose From 3 Complexity Levels

Laceration repair codes are broken into three categories: simple, intermediate and complex, says Caral Edelberg, CPC, CCS-P, CHC, president of Medical Management Resources for TeamHealth, Jacksonville, Fla.
 
You can follow these ground rules for deciding among  complexity levels for laceration repairs:

- A simple repair is usually single layer, with no particulates, no contamination. You-ll report simple repairs with codes from the 12001-12021 CPT family, depending on the length and location of the repair.

- An intermediate repair usually involves layered closure of one or more of the deeper layers in addition to the skin, or a single layer repair that requires extensive cleaning and removal of particulate debris. Check the 12031-12057 code set when you-re filing claims for intermediate repairs, depending on the length and location of the repair.

- A complex repair usually includes the repair of wounds requiring more than layered closure using wound techniques such as extensive undermining, stents, or retention sutures. Management of the wound usually includes creation of a defect for repairs or the debridement of complicated lacerations or avulsions. Complex repairs are reported with codes 13100-13160.

So if the physician closes a simple 1.5-cm laceration to a patient's left eyebrow, you would report 12011 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less) for the service.

Combine Repair Lengths in Same Anatomic Area

When the physician closes more than one laceration during an encounter, don't just assume you can add up the total length of the repair and choose a code. You can only add repair lengths together if they are in the same anatomic region and of the same complexity, Edelberg says. The following examples illustrate CPT's rules for multiple laceration repair coding:
 
Example 1: The physician treats a patient with two simple lacerations on her arm, 1.5 cm and 2.3 cm. Since both are considered simple and in the same anatomic location, you should add the length of the two repairs (3.8 cm) and report 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.6 cm to 7.5 cm).

If the 2.3-cm laceration repair was intermediate and the 1.5-cm repair was simple, however, you would bill them separately: 12031 (Layer closure of wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.5 cm or less) for the intermediate repair and 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) for the simple fix.

Example 2: The physician performs a 2.0-cm simple repair of the arm and a 4.0-cm simple repair of the forehead. Since these repairs were in different anatomic areas, you would report separate codes for each, Blakeman says: 12001 for the arm and 12013 (... 2.6 cm to 5.0 cm) for the forehead repair.

Scalp Laceration Repairs Common in ED

While there is no definitive list of ICD-9 codes you-ll use for laceration repairs, many of the codes you-ll need are in the 870-897 range, Edelberg says. -These codes encompass uncomplicated wounds, complicated wounds, wounds involving tendons, etc.,- Edelberg says.

Some of the diagnosis codes most commonly used when the physician performs laceration repair are:

- 873.0 -- Other open wound of head; scalp, without mention of complication
- 873.4x -- - face, without mention of complication
- 883.0 -- Open wound of fingers; without mention of complication
- 892.0 -- Open wound of foot except toe(s) alone; without mention of complication
- 892.1 -- ... complicated
- 892.2 -- - with tendon involvement
- 893.0 -- Open wound of toe(s); without mention of complication
- 893.1 -- ... complicated
- 893.2 -- ... with tendon involvement.