ED Coding and Reimbursement Alert

Question: If the physician closes a wound using Dermabond, should we report a simple laceration repair code? I have heard conflicting information.


Michigan Subscriber

Answer: If you-re sending the claim to a private payer, you should report the appropriate laceration repair code, such as 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk, and/or extremities [including hands and feet]; 2.6 cm to 7.5 cm) or 12042 (Layer closure of wounds of neck, hands, feet, and/or external genitalia; 2.6 cm to 7.5 cm). These codes include repair with Dermabond.

According to CPT's instructions for the -Repair (Closure)- codes, you are to -use the codes in this section to designate wound closure utilizing sutures, staples, or tissue adhesives, either singly or in combination with each other, or in combination with adhesive strips.-

For Medicare patients, you should report G0168 (Wound closure utilizing tissue adhesive[s] only) for a simple repair and the appropriate CPT code for intermediate and complex repairs.

In a nutshell, Medicare believes that the work value for Dermabond closure is not the same as the work value for suture closure, so it won't pay the fees associated with 120xx codes when the physician performs the repair with Dermabond.