ED Coding and Reimbursement Alert

Question: In our ED, we recently saw a Blue Cross patient who had Dermabond applied to a forehead laceration. Should we use only code 12011* (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less), or should we use 12011 and G0168 (Wound closure utilizing tissue adhesive[s] only)? Is G0168 only for Medicare patients? Also, is this code only used for facility outpatient coding (APCs) or is it applied to both the physician and facility billing? I always thought that it was to be used by both sides, but I want to make sure.

South Carolina Subscriber

Answer: Code G0168 is for a Medicare patient who has a superficial laceration repair with Dermabond only. G0168 is also used on the facility side for Medicare patients receiving Dermabond. For all other carriers, 12011 is appropriate.

Remember that if you bill Medicare for closing a laceration with Dermabond only, use code G0168. If you use both sutures or staples and Dermabond, only bill the layered laceration repair code, based on the length and site of the wound. These rules apply in both the inpatient and outpatient settings. CPT instructs you to use only the appropriate repair code for closures using tissues adhesives.