Look to Repair Length for Accurate Code Choice
Question: Encounter notes indicate that the emergency department (ED) triage reported that a patient had a “R hand laceration, approx 2.5 cm.” When reviewing the ED physician’s notes, however, I added up at least 3.5 cm of intermediate repair length. Which length should I base my CPT® code choice on? Revenue Cycle Insider Subscriber Answer: Code choice is based on the length of repair, not the length of the wound. On your claim, you should choose 12042 (Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm) with modifier RT (Right side) appended to indicate laterality, if the payer requires it. Determining the correct length of the repair is crucial. In this case, if you had coded based on triage’s estimation, you would have chosen the lower-paying (and inaccurate) 12041 (… 2.5 cm or less). Occasionally, nursing or triage will identify one length and the physician’s notes will indicate another. Nursing or triage never measures wounds; they usually only estimate their diameter. CPT® is more precise in its demands; they want the length of all angles of repair, not the estimated diameter of a wound. For example, a wound with jagged edges or stellate (several angles around a circle of injury) may need repair outside of the estimated wound length. Merely measuring the wound doesn’t take into account other angles of the wound that may also require repair. But, if you measure all angles of repair after closure, as CPT® requires, your estimated 2.5 cm diameter laceration might have 3 or 4 cm of repair along the several edges of the wound. On your specific claim, if the repair was 3.5 cm exactly, it might be a good idea to ask the physician to document “3.5 cm by repair” to distinguish it from the estimated diameter in the nursing notes. Chris Boucher, MS, CPC, Senior Development Editor, AAPC
