ED Coding and Reimbursement Alert

READER QUESTIONS:

Extra Cleaning Earns Intermediate Repair

Question: The ED physician removed extensive debris from a wound that then required a single-layer closure. Should I report this service with a code for wound repair or a code for foreign-body removal?


Ohio Subscriber
Answer: You should report an intermediate code for the repair--for example, 12041 (Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less), given that the doctor is performing extensive removal of particulate debris. CPT allows for the reporting of single layered closure of wounds requiring extensive removal of debris with the intermediate repair codes. 

Tip: CPT states that -single-layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair.- Payers following CPT rules recognize the extra work of the extensive cleaning and removal through more intensive and higher-valued intermediate repair codes.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

ED Coding and Reimbursement Alert

View All