ED Coding and Reimbursement Alert

Question: A patient reports to the ED after stepping on a rusty nail at a picnic. After examining the patient and making sure the wound was free of debris, the ED physician orders a tetanus injection and repairs the 0.8 cm “hole” in his right foot with sutures. Notes indicate a level-three E/M service. Can I also report a laceration repair code in this scenario?

Indiana Subscriber

Answer: Since the ED physician used sutures for the repair, you can submit a laceration repair code. The tetanus injection is not reportable on the professional side in the facility setting.

On the claim, report the following:

99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of moderate complexity…) for the E/M

modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99283 to show that the E/M was separate from the other services

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) for the repair

892.0 (Open wound of foot except toe[s] alone; without mention of complication) appended to 12001, and 9983 to represent the patient’s injury.

Under ICD-10 that diagnosis would be S91.309A (Open wound of foot except toe[s] alone without mention of complication.)