ED Coding and Reimbursement Alert

Question: A patient reports to the ED after stepping on a rusty nail at a picnic. After examining the patient and making sure the wound was free of debris, the ED physician performs a tetanus injection and repairs the 0.8 cm hole in his right foot with sutures. Can I report a laceration repair code in this scenario?

Indiana Subscriber

Answer: Since the ED physician used sutures, you can submit a laceration repair code. However, tetanus shots are not reportable in the ED, so roll the injection work into the overall E/M level.

On the claim, report the following:

" 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) for the repair

" the appropriate-level E/M code, such as 99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity &)

" modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to the E/M code to show that it was separate from the other services

" 892.0 (Open wound of foot except toe[s] alone; without mention of complication) appended to 12001 and the E/M to represent the patients injury.