ED Coding and Reimbursement Alert

LLLDTEAR lights the way for coders

So you-ve mastered the ins and outs of CPT coding for laceration repairs; now all you have to do is make sure your documentation is airtight, and your claim is on its way to acceptance.

Coders who want to stay on top of laceration repair coding should remember this acronym: LLLDTEAR.

Huh? While the term might be unwieldy and unpronounceable, it is also very handy when documenting laceration repairs, says Jim Blakeman, senior vice president at Emergency Groups Office in Arcadia, Calif.

-A good procedure note is the key to proper documentation and coding of wound repairs,- he says. The eight components of LLLDTEAR reflect the elements that you should have on your wound care claims:

- Location 
- Length
- Layers
- Decontamination (including foreign material removed)
- Tissue management
- Exploration of wound and contiguous structures
- Anesthesia technique
- Repair of underlying structures.

Blakeman also offers this quick advice on backing up your wound repair coding:

- The physician should always state locations of each separate repair, describing separately the multiple sites and lengths on the same patient.

- Measure the laceration only AFTER the repair, and combine the total lengths of all angles of the repair (for instance, flap or stellate repair). Comment on length as
-X cm. by repair- to distinguish the repair length from the wound length. Remember, length includes the full length of the wound edges, even if the outside stitch does not cover the furthest point of the wound.

- Describe the wound's edges (ragged, jagged, stellate, flap) and whether it required extensive cleansing beyond the normal surgical prep. Note the possibility of injury to adjacent structures, such as tendon involvement, and, if repaired, this should be clearly documented.

- Always state the type of suture material used, and if drains were placed. If a layered closure was performed, state the number of layers or your estimation of the complexity of the closure (simple, intermediate, complex).

- Describe the risk of infection and note if grossly contaminated or if debridement was required and whether any foreign material was removed from the wound site. Describe the foreign material (such as paint chips, dirt or steel shaving).

- State the anesthetic agent and method (nerve block, 2 percent lidocaine, surface infiltration).