ED Coding and Reimbursement Alert
Check Location Length and Layers When Assigning A Laceration Repair Code
Question: Can we report a complex laceration repair code use given this chart note?
10 cm linear laceration of right upper forehead; betadine, wound irrigation:saline,foreign body removal:yes, multiple pieces of dirt and gravel removed by hand and irrigation, re-explored and no dirt or FBs seen; lidocaine:1%, with epinephrine 10cc square; 2 layers, deep layers repaired w/simple interrupted absorbable 3-0 vicryl sutured and skin layer repaired w/staples, 13.
Wisconsin Subscriber
Answer: The first question is whether “upper forehead” means the face or the scalp. Assuming face, the code would be 12054(Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm). If scalp it would be 12034 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm). It is an intermediate repair because of the multiple layers and extensive cleaning.
The extensive cleaning that was documented can take you from simple to intermediate, but not from intermediate to complex. According to CPT®, a complex repair requires more than layered closure, viz., scar revision, debridement for traumatic lacerations or avulsions, extensive undermining, stents or retention sutures. The chart note offered does not reflect interventions such as debridement.
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