ED Coding and Reimbursement Alert

Question: A patient reports to the ED with bleeding following a tooth extraction. After a level-two E/M, the physician uses two sutures to close the wound (the repair is approximately 0.9 cm total). How should I code the suturing service? Should I use a dental code?

Michigan Subscriber

Answer: For this procedure, there is a HCPCS "D" code, D7910 (Suture of recent small wounds up to 5 cm). But these codes are designed for dental professionals, not ED physicians.

You are better off using a laceration repair code for this scenario. On the claim, report the following:

- 12011 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less) for the repair

- 873.60 (Other open wound of head; internal structures of mouth, without mention of complication; mouth, unspecified site) linked to 12011 to represent the patient's injury

- 99282 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making of low complexity) for the E/M

- modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) linked to 99282 to show that the E/M and the repair were separate services

- 873.60 linked to 99282 to represent the patient's injury.

-- Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass.