ED Coding and Reimbursement Alert

Know when - and when not - to add wound lengths

Need to fine-tune your skills at reporting laceration treatment in the ED? See if you can correctly code these three challenging scenarios and home in on your coding trouble spots.
 
Scenario #1: A patient presents to the emergency department (ED) with a 1.5-cm laceration of the eyebrow, and the physician performs an intermediate repair. The patient also has a 3.6-cm forehead laceration that requires a simple repair. Should you add these two wound lengths together and then code the intermediate repair, or does each get its own code?
 
Answer: 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 eyebrow repair and 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 forehead repair.
 
Don't sum the wound lengths - you should only combine or add the lengths of like wounds when they're located in the same anatomical area and are of the same classification. In this case, you would report the intermediate wound separately from the simple closure, and append modifier -51 (Multiple procedures) only to the simple repair code.
 
Remember: You also need to report these two repairs separately because they are not the same type of repair - one is simple, and the other is intermediate. If they were both simple, or both intermediate, and located in the same anatomical area, then you would add their lengths together and report one repair code.
 
According to CPT, "When multiple wounds are repaired, add together the lengths of those in the same classification and from all anatomic sites that are grouped together into the same code descriptor." The classifications that CPT refers to are "simple," "intermediate" and "complex" repairs, says Yvonne Mayer, CPC, with Bill Dunbar and Associates in Indianapolis.
 
Scenario #2: The ED physician repaired the patient's lacerations using Dermabond in three separate places on the left arm. Should you report three repairs, or just charge for one?
 
Answer: Most carriers recommend that you code Dermabond as a simple closure, so you should add these wound lengths together and only report one simple repair code, says Sharon Robertson, CPC, with the department of emergency medicine at the Louisiana State University Health Sciences Center in Shreveport, La.
 
Choose the most accurate code from the 12001-12007 series (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet] ...).

Scenario #3: A patient presents to the ED after falling off her bike, and has a 3.5-cm gash on her left knee. The accident happened on a dirt path, so the cut is full of gravel and debris. The doctor spends a lot of time cleaning the wound to remove the debris before performing a single-layer repair. How should you report this?
 
Answer: Examine the physician's documentation closely for this patient because although the physician only used a single-layer repair technique, this may qualify as an intermediate repair, says Michael A. Granovsky, MD, CPC, FACEP, vice president of MRSI in Stoneham, Mass.
 
CPT states that "single-layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair." This caveat allows you to report intermediate codes for well-documented single-layer repairs that are heavily contaminated. "The key here is the description 'extensive cleaning,' " Granovsky says.
 
For example, if the physician says he "sutured" the wound but doesn't document anything to the effect of "extensive cleaning" or "removal of particulate matter," you'll have to report 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.6 cm to 7.5 cm). However, if the doctor did specify that he performed the extensive cleaning, you can report 12032 (Layer closure of wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.6 cm to 7.5 cm), which is ultimately more reflective of the work the physician performed.