ED Coding and Reimbursement Alert

Question: A young man was recently seen in our ED with a laceration that had a large sliver embedded within it. The physician removed the foreign body and performed a simple repair. May we assign a wound exploration code in addition to the repair?

South Dakota Subscriber

Answer: It depends on the work performed and documented by the ED physician. Generally, however, simple removal of a sliver and wound closure would not justify a wound exploration code (20100-20103). These codes are intended for injuries sustained from penetrating trauma, and the code definitions require that the wound require enlargement, extension or dissection to determine penetration.
 
In the situation described, it is most likely that the appropriate repair code would be assigned (e.g., 12004*, simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk, and/or extremities [including hands and feet]; 7.6 cm to 12.5 cm]). If the simple wound required extensive cleansing or debridement (as may be the case in this example), a simple repair may be considered an intermediate repair and reported as such. Also, depending on the documentation of the work performed by the physician, 10120 (incision and removal of foreign body, subcutaneous tissues; simple) might be used. The physician would have to have extended the wound or opened it in some manner, a circumstance that occurs regularly.

  Reader Questions and You Be the Coder were reviewed by John Turner, MD, PhD, medical director of Documentation and Coding Compliance for Team Health in Knoxville, Tenn.; and David McKenzie, director of Physician Reimbursement, American College of Emergency Physicians, Texas.