ED Coding and Reimbursement Alert

Code repairs that occur in same area separately -- sometimes.

Patients often report to the ED with multiple lacerations -- and coding will vary depending on several factors.

Remember: The location and type of closure will tell you whether to add [the repairs] together or use separate codes, says Kevin Arnold, CPC, business manager for the Emergency Medicine Department at Connecticuts Norwalk Hospital. Check out these brief case studies so you can cut to the quick when coding more than one laceration fix on the same patient.

Case 1: Cuts of the Same Severity, Location

The first step in coding multi-laceration repairs is to look to the type of closures; if they are the same type & and both repairs are located in the same anatomical location, then you would add them together, explains Arnold.

For example, the ED physician performs a 2.1 cm intermediate repair on a patients left ear, and an intermediate 3.4 cm repair on her left cheek.

In this instance, you would add the repair lengths (2.1 + 3.4 = 5.5) and choose 12053 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips, and/or mucous membranes; 5.1 cm to 7.5 cm) for the encounter.

Case 2: Cuts of Differing Severity, Same Locale

If the patient has lacerations in the same anatomical grouping, but the severity differs, report a code for each repair, Arnold confirms. For example, the ED physician  performs intermediate repair of a 2.3 cm cut on a patients right shoulder, and a simple repair of a 3.4 cm laceration on the patients lower back.

In this instance, you would report the following:

" 12031 (Repair, intermediate, wounds of scalp, axillae, trunk, and/or extremities [excluding hands and feet]; 2.5 cm or less) for the shoulder repair

" 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) for the back repair.

Case 3: Cuts of Differing Location

When a patient suffers lacerations to different anatomical areas, submit codes for each repair -- even if the cuts are of the same severity.

For example, lets say the ED physician performs a simple repair of a 7.0 cm cut on a patients right arm and a simple repair of a 2.4 cm cut on her lower forehead. In this instance you would report the following:

" 12002 for the arm repair

" 12011 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips, and/or mucous membranes; 2.5 cm or less) for the forehead repair.

Cleaning Equals Intermediate? Not So Fast

To file the most accurate cut-repair claims, ED coders need to know the definition of intermediate repair, for coding purposes. The intermediate codes come into play when the physician performs layered closure of one or more of the deeper layers of subcutaneous tissue and superficial non-muscle fascia in addition to the skin, relays Arnold.

A heavily contaminated single-layer repair that calls for extensive cleaning or removal of particulate matter might also be an intermediate fix -- but a rote cleaning of the site pre-procedure does not elevate the repair to intermediate.

Most lacerations will have some degree of particulate matter removed; in order to assign an intermediate repair, the work involved in removing the matter must be extensive and above what is considered normal removal or cleaning, explains Arnold.

Best bet: Coders who are unsure about what constitutes an intermediate repair should consult with physicians before coding.