ED Coding and Reimbursement Alert

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.