ED Coding and Reimbursement Alert

Consider Payer for Lip Repair Code

Question: A patient had a through-and-through lip laceration. The physician's documentation supports simple closure with three nylon sutures for the outer lip (1 cm) and seven catgut sutures for the intraoral repair (2.5 cm). Should I report an intermediate repair with 12052, or a simple repair of the outer layer with 12011 and then 40830-51 for the intraoral one-layer closure?

Virginia Subscriber

Answer: Both scenarios are reasonable, depending on the physician's documentation. Additionally, if the vermillion border was involved, you might consider 40652 (Repair lip, full thickness; up to half vertical height) if the documentation supported this more extensive procedure. In these cases, sometimes the simplest code choices make things easiest on the back end.

Although both choices are acceptable, many groups will use 12052 (Layer closure of wounds of face, ears, eyelids, nose, lips, and/or mucus membranes; 2.6 cm to 5.0 cm), since it is more familiar to payers. However, reporting 12011 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less) and 40830-51 (Closure of laceration, vestibule of mouth; 2.5 cm or less; multiple procedures) is also legitimate.