ED Coding and Reimbursement Alert

Question: A patient with a penetrating wound on his upper thigh came into the ED. He was injured by a bullet fragment at the shooting range. After performing a level-four evaluation and management service to check for trauma to other systems, the physician performed a significant exploration of the wound to check for further damage to the wounded extremity. She then irrigated the wound and packed it open. Can we report the exploration and the wound closure separately?


Illinois Subscriber


Answer: No, you cannot. You-ll report two codes for this encounter; one for the E/M service and another for the exploration; payers consider wound closure part of the exploration.


On the claim:

- report 20103 (Exploration of penetrating wound [separate procedure]; extremity) for the exploration.

- report 99284 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a detailed history; a detailed examination; and medical decision-making of moderate complexity) for the E/M service.

- attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99284 to show that the wound exploration and closure were separate services from the E/M.

- link 890.0 (Open wound of hip and thigh; without mention of complication) to 20103 and 99284 to represent the patient's leg injury.