ED Coding and Reimbursement Alert

Question: An elderly patient presented in our ED with a half-circle skin tear on his forearm. The physician cleaned the wound and repaired it with Dermabond. Should I charge for a laceration repair?         

Arizona Subscriber
 
Answer: Medicare has recently implemented a G code that describes this service precisely: G0168 (Wound closure utilizing tissue adhesive[s] only). But if you're dealing with a non-Medicare patient receiving a single-layer closure, you'll need to select the appropriate code from the 12000 series for simple laceration repairs, depending on the length of the repair.
 
For example, if the repair measures less than 2.5 centimeters, you'd report 12001 (Simple repair of superficial wound of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less). For repairs of greater length, you would report one of the following codes:

  12002 - ...2.6 cm to 7.5 cm
  12004 - ...7.6 cm to 12.5 cm
  12005 - ...12.6 cm to 20.0 cm
  12006 - ...20.1 cm to 30.0 cm
  12007 - ...over 30.0 cm.

Remember that correct measurement of the repair is crucial to your reimbursement, so make sure your physician documents her findings.