ED Coding and Reimbursement Alert

Some deep cuts require only simple closure

Laceration repair coding can get difficult fast: You-ll have to determine the complexity, length, and number of repairs the physician makes before filing. Follow this expert advice on laceration treatment coding, and you-ll be able to cut through any claim confusion.

Almost 7 percent of ED patients receive some form of wound care, says Jim Blakeman, senior vice president at Emergency Groups Office in Arcadia, Calif. -As the most commonly reported surgical procedure in the emergency setting, accurate coding and documentation has a considerable economic impact on the practice,- he says.

Make Sure Service Qualifies as Wound Care

According to Nancy Reading, RN, CPC, director of educational services for the American Academy of Professional Coders (AAPC), you need to check if the physician's actions constitute wound repair in CPT's eyes. Otherwise, you should report an E/M code for the service instead of a laceration repair code.

CPT definition: Repair codes designate closure utilizing sutures, staples or tissue adhesive, either singly or in combination with each other, or in combination with adhesive strips.

In other words, if your physician applies any tissue adhesive or places a single stitch or staple, you can report the service with wound care codes, Reading says.

Take note: Although you will report wound closure using tissue adhesives such as Dermabond with the CPT procedural code, report repairs using adhesive strips (Steri-strips) as the sole repair material with the appropriate E/M code.

Pay Attention to Complexity for Coding Accuracy

CPT groups laceration repair codes by anatomic location and complexity. There are repair codes for each anatomic region in the laceration repair section of CPT, but the groupings vary by complexity.

For example, hands, feet, neck and external genitalia are part of the descriptor for simple repairs 12001-12007 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities ...). However, for intermediate repairs, these regions have their own set of codes (12041-12047, Layer closure of wounds of neck, hands, feet and/or external genitalia ...). 

Best bet: Read the descriptors carefully before choosing a code, to make sure you are in the proper anatomic region.

Physician Actions, Layers Determine Wound Type

After you-re sure the physician performed a CPT-approved laceration repair, focus on wound complexity. CPT requires coders to report repairs according to the three levels of treatment classification: simple, intermediate or complex.

- Simple repairs occur when the laceration is a single layer, with no particulate or contamination, Blakeman says. You will report these encounters with a code from 12001-12021.

Medicare exception: If the physician uses Dermabond as the only closure material on a simple repair, Medicare requires a separate code for the closure, regardless of length, Blakeman says. Suppose your physician performs a single-layer repair using the tissue adhesive Dermabond on a Medicare patient's wound with no particulate matter or contamination present. You should report G0168 (Wound closure utilizing tissue adhesive[s] only) for this encounter on the professional side.

If the closure is intermediate or complex and the physician uses Dermabond, report the normal repair codes, Blakeman says. (CPT does not recognize G0168 and considers most Dermabond closures simple fixes.)

- Intermediate repairs involve two layers of skin or a single layer with significant particulate debris or contamination. You should report these repairs with a code from 12031-12057. If the notes mention -layered closure,- the physician probably performed an intermediate repair, Reading says.

But -depth of the repair alone would not justify increasing the complexity,- Blakeman says. During the repair of a deep subcutaneous wound, the physician would also have to close a secondary layer (such as the skin) in order to report an intermediate or complex code. The reason? Some deep subcutaneous wounds can be closed with a single layer.

Remember the layered exception: CPT directs you to report intermediate repair codes for wounds closed with single-layer repairs that are heavily contaminated and require extensive cleaning, says Michael A. Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass.

Suppose after a fall a patient reports to the ED with a 2.1-cm single-layer laceration on her forehead. The wound is contaminated with gravel and some dirt, and the physician spends significant time cleaning and removing debris from the repair site. You should report 12051 (Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less) for the service.

- Complex repairs require more than layered closure and might include scar revision, debridement of traumatic laceration, or extensive undermining. On these repairs, make sure the physician documents the complexity of the repair along with an explanation as to what made the
fix complex.

Complex repairs might involve techniques such as -creation of a defect, stents or retention sutures. If your physician mentions repair to the depth of muscle or deeper, be alert for the use of techniques that may indicate he performed a complex repair,- Reading says.

2-Plus Repairs Might Mean Multiple Codes

When the physician performs more than one laceration repair in a single session, you may be able to report a pair of wound care codes. However, some multi-repair scenarios may result in a single wound care code.

In short: If the repairs are of the same complexity and in the same anatomic region, add the lengths of the two repairs and choose a code based on the sum. If the fixes occur in separate regions, or if the wounds- complexities differ, you will report separate codes for each.

Single-code example: The ED physician makes a 2-cm simple repair on a patient's arm and a 4-cm simple repair on his chest. The complexity and anatomic region of these repairs are the same, so you would add the repair lengths and report 12002 (... 2.6 cm to 7.5 cm).

Multi-code example: A child crashes her bicycle, cutting her face (3 cm), both hands (3 cm and 5 cm), both arms (4-cm left and 9-cm right) and right leg (12 cm). Though all the repairs are single-layer, the physician has to remove extensive particulate matter and debride the child's leg wound.

In this case, you will report simple repair codes for all of the fixes except the right leg, which was an intermediate repair. On the claim, report the following:

- 12034 (... 7.6 cm to 12.5 cm) for the leg repair.

- 12006 (... 20.1 cm to 30.0 cm) for the repairs to the patient's arms and hands. You arrive at this code by adding the length of the repairs to both arms (13-cm total) and both hands (8-cm total).

- 12013 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm) for the face repair.

Remember: When reporting more than one wound care code, -list repair codes in order of complexity -quot; highest first,- Blakeman says.