ED Coding and Reimbursement Alert

Report with wound repair codes, include in E/M code … or something else?

Laceration repairs are probably the most common procedure performed in most EDs — but not all laceration repairs are created equal.

When reporting laceration repair, treating a laceration with Surgicel or other hemostatic agents should be factored into the coding process. The use of hemostatic agents also might help decide which coding path you take for laceration repair encounters.

Read on for more information on laceration repairs and Surgicel and other hemostatic agents.

Know Surgicel, Dermabond Differences

Accurate coding for laceration repairs requires understanding the laceration’s location, length, depth, and repair method. In cases where treatment other than sutures or staples is used, coders must consider how the chosen treatment modality interacts with the wound.

Surgicel is a widely used hemostatic agent that helps control bleeding during procedures and promotes the formation of blood clots. When applied to a wound, Surgicel absorbs blood and other fluids, forming a gel-like substance that seals the wound and aids in the healing process. It is important to note that Surgicel is primarily used for hemostasis and bleeding control, often in conjunction with other closure techniques like sutures or staples.

Dermabond and other tissue adhesives are liquid adhesives used to close minor or superficial wounds. When applied to the skin, Dermabond forms a flexible, waterproof seal that holds the wound edges together during the healing process. Dermabond is often used as an alternative to traditional sutures or staples, as it eliminates the need for suture removal and can provide a more aesthetically pleasing outcome.

To determine the appropriate coding for a laceration repair involving Surgicel versus one repaired with Dermabond, the specific characteristics of the wound and the outcome of the treatment must be considered. According to CPT^®, codes in the surgical section should be used to report wound closure utilizing tissue adhesives like Dermabond. In the ED, you’ll most likely see these services reported with codes from the 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/ or extremities (including hands and feet); 2.5 cm or less) through 12057 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm) range.

Example: A 6-year-old child has a 1.5 cm laceration behind their left ear from a playground accident. The emergency physician gets a history including tetanus status, cleans and examines the wound, and decides to close the wound using tissue adhesive rather than sutures.

Report this service with code 12001 along with an ED evaluation and management (E/M) code from the 99281 (Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional) through 99285 (Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making) code set. Remember to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M to show that the repair and E/M were significant, separately identifiable services.

However, when a hemostatic agent like Surgicel is used solely for bleeding control, it aligns more closely with cauterization, which CPT^® states should not be separately reported. The primary purpose of Surgicel is to control the bleeding. Unless the wound is also secured with sutures, staples, or tissue adhesives, the Surgicel application should be included the appropriate ED evaluation and management (E/M) code rather than being separately reported with a laceration repair code.

Example: The laceration is approximately 1.2cm in length and is located on the anterior surface of the tongue. The patient was placed in the supine position and adequately prepped and draped in a sterile fashion. Hemostasis was achieved by gently applying pressure with sterile gauze. The tongue laceration was carefully inspected for foreign bodies or debris that were not found. The wound edges were gently cleaned using sterile saline solution and a cotton swab. Hemostasis was ensured by applying direct pressure to the bleeding vessels using sterile cotton swabs.