ED Coding and Reimbursement Alert

Also, remember to check notes for E/M service

If a patient reports for laceration repair to a wound that requires a layered closure, extensive cleaning, or removal of particulate/foreign bodies, you-ll likely be able to report a code from the intermediate repair set (12031-12057).
 
Caveat: Deep wounds do not always require intermediate repair, says Caral Edelberg, CPC, CCS-P, CHC, president of Medical Management Resources for TeamHealth, Jacksonville, Fla.

-Depth of the repair alone would not justify increasing the complexity. [The notes] would also have to indicate that a secondary closure technique was necessary, because some deep subcutaneous wounds can be closed with a single layer,- Edelberg says.

Consider this clinical example of an intermediate laceration repair, courtesy of Edelberg:

Patient condition: A 14-year-old patient presents with blunt trauma to the hand sustained when he jumped into a wagon while visiting a farm. His left hand has a laceration over the dorsum near the MCP joint and extending proximally from there. The wound is 3 cm and extends down to the fascia.

Physician action: The ED doctor applies a tourniquet and examines the wound, finding no solid evidence of arterial or tendon injury. After anesthesia by direct infiltration, she irrigates the wound with normal saline solution.

The physician then places #4-0 Vicryl sutures into the fascia layer and makes the primary closure with seven interrupted #3.0 Ethilon sutures. The physician's history, physical examination and medical decision-making are consistent with a level-three  evaluation and management service.

On the claim, you should:

- report 12042 (Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm) for the repair.

- report 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making of moderate complexity) for the E/M service.

- append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99283 to show that the E/M service was separate from the repair.

- prove medical necessity by attaching the following ICD-9 codes to 12042 and 99283:
 
--882.0 -- Open wound of hand except finger(s) alone; without mention of complication

--E849.1 -- Place of occurrence; farm

--E917.9 -- Striking against or struck accidentally by objects or persons; other striking against with or without subsequent fall.

Note: Just about all laceration repair patients will require a separate E/M service in order for the physician to determine:

- the extent of injury

- whether there is any pertinent underlying medical condition that might have affected the injury.

(For more information on laceration repair coding, see -Add Laceration Repair Lengths That Have Common Attributes- later in this issue)