ED Coding and Reimbursement Alert

Question: If our ED physicians remove several particles or foreign bodies from a penetrating wound, should we report the appropriate wound exploration code more than once? Or should the codes be reported only once per encounter?

Florida Subscriber

Answer: Practices should report the code only once per wound per anatomical site. CPT provides four wound exploration codes, and the removal of multiple foreign bodies is included in each code. However, if multiple wounds are explored and identified at separate anatomical sites, the appropriate code for each wound site may be used.
 
If there were wounds in the back of the neck and on the trunk, for instance, 20100 (exploration of penetrating wound [separate procedure]; neck) and 20101 ( chest) are assigned. On the other hand, if multiple foreign bodies were taken from two wounds in a patient's left leg, 20103 ( extremity) should be reported only once.
 
Wound exploration codes include a wide range of services, according to CPT notes:
  surgical exploration and enlargement of the wound
  extension of dissection to determine penetration
  debridement
  removal of foreign bodies
  ligation or coagulation of minor subcutaneous or muscular blood vessels, of the subcutaneous issue, muscle, fascia, and/or muscle that does not require thoracotomy or laparotomy.

Coders should note that if exploration and repair were performed on any major anatomical structure or major blood vessel requiring thoracotomy or laparotomy, those procedure codes supersede the use of 20100-20103. In addition, simple, intermediate or complex repair of wounds that do not require enlargement of the wound, extension of dissection or other services stated above, is reported with specific repair codes in the integumentary system section of CPT (12001*-13160). Treatment of superficial wounds that might include removal of foreign bodies, but require no significant exploration, is coded with the appropriate incision and removal code from the corresponding anatomical section of CPT (e.g., 28190*-28193 for wounds of the foot, 23330-23332 for wounds on the shoulder, or 67938 for wounds on the eyelids).