ED Coding and Reimbursement Alert

Health care providers across the country were excited when, in August, the U.S. Food and Drug Administration (FDA) approved the topical skin adhesive, Dermabond (2-octyl cyanoacrylate), for market release.

The liquid adhesive has been FDA-approved for closing certain topical incisions and lacerations that are currently repaired using staples, sutures, or adhesive strips.

Unlike staples and sutures, Dermabond does not require the administration of an anesthetic, and it can be used to repair lacerations and incisions that are deeper and more complex than those that can be closed with adhesive strips.
However, the use of Dermabond has been slowed, particularly among emergency providers, because of concerns about billing and reimbursement.

At $28 per tube and one tube per application, the adhesive is significantly more expensive to EDs and physician practices than the cost of providing suture repair. And, because there is no CPT code for Dermabond application, many EDs arent sure theyll be able to get any reimbursement for performing laceration repair this way.

We would like to provide it, particularly for pediatric patients. Parents are hearing that its available and are coming in and wanting it, says Patricia L. Keith, administrator in the Department of Emergency Medicine, University of Massachusetts Medical Center. But, we arent sure whether or not we are going to get reimbursed for it. I doubt anyone has gotten word from an insurance company on whether they will accept it.

Bill Reifert, MD, of Emergency Physicians, a two-physician emergency medicince practice in Fort Collins, CO, agrees, but says he would assume that practices could bill laceration repair the same way they bill when sutures are used.

I assume we would still get a laceration repair charge for that, he states. Were doing the same thing, were just not using sutures, were using glue. We still have to go through all those gymnastics of cleaning the wound and figuring out what kind of wound it is, and all of that. Its the same medical process.

Tips: Laceration repair codes are found in the Surgery section of CPT, under Integumetary System, Repair.
Although the laceration repair codes may not completely cover the cost of using Dermabond in some cases, they will at least get the ED group some reimbursement, as opposed to the unlisted procedure codes, which are often not recognized by third-party payers.

Why Not Use Laceration Repair Codes?

According to David McKenzie, director of the American College of Emergency Physicians (ACEP) reimbursement department, the CPT definition of laceration repair does not say the repair must be performed with sutures, but it does purposefully exclude use of these codes with adhesive strips.

ACEPs coding and nomenclature advisory committee spent a
significant amount of time discussing this situation at the Colleges last scientific assembly in October.
The College will probably issue an [...]