ED Coding and Reimbursement Alert

Question: We’ve noticed that one of our physicians reports the diagnosis code for a closed wound even when he’s clearly treating open lacerations and repairing the wounds. Can you give us a clear description of how to differentiate an open wound from a closed wound? And does open wound treatment automatically mean we can choose a procedure code?

Washington Subscriber

Answer: A closed wound is any wound where the skin is not broken, most frequently a bruise. An open wound occurs when the skin is cut, torn, or punctured. The most common types of open wounds are abrasions, avulsions, incisions, lacerations, and punctures. If you see any of these terms in the notes, and evidence that the skin was breached, your provider might have performed open wound treatment.

Closed wound example: A patient reports to the emergency department with a badly bruised forearm. Another example could be a broken bone that doesn’t break the skin.

Open wound example: A patient presents with a badly bruised forearm. The patient also suffered several abrasions to the bruised area, a puncture wound, and bits of sand in the wound.

Open wound treatment does not automatically result in reporting a procedure code, however. Some superficial open wounds will only qualify as evaluation and management (E/M) services.

Do this: Check the notes for the closure method. CPT^® typically considers the following techniques as qualifying for wound closure coding: sutures, staples, or tissue adhesives. The ED physician might use one or more of these techniques to perform a wound repair service that you might code as a procedure.

For example, if notes indicate that the physician used staples and sutures to close a patient’s 2.1 cm superficial neck wound, you’d report 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.

If the provider closed a wound with only adhesive strips, however, you would likely report the appropriate emergency department E/M code.