ED Coding and Reimbursement Alert

Question:  Can you help us with this scenario? A patient arrives with a gaping wound on his toe involving tendons. 

The ED physician stitches it closed “loosely.”  The patient is referred to the specialist for open wound repair the following day.  Would you code the laceration repair in the ED?

Second scenario.  Patient fractures her finger and there is an open wound.  The ED physician performs a loose simple repair. Patient is referred to specialist for open fracture care in the next day or so. 

Would you code the laceration repair in the ED?

Virginia Subscriber

Answer:

You should be able to report the repairs in both scenarios. The documentation meets the definition of a repair according to CPT®. 

For the first scenario, the repair might normally be intermediate because of the damage to underlying fascia, but that was not the repair provided here. Consider code 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), assuming the toe repair is 2.5 cm or less.

The second scenario is very similar with the same code likely unless the finger repair took longer than the toe repair. No modifiers would be required since these are zero day global codes with no follow up included in the value.