ED Coding and Reimbursement Alert

Question: A patient presented with a partial traumatic amputation of his distal fingertip, and the ED physician determined that he couldn't replant the fingertip. A portion of the distal phalanx bone was protruding from the amputation. The physician used a bone rongeur instrument to debride, and rounded the bone in order to close the wound over it. Should I report a debridement or an amputation code?
             
Vermont Subscriber Answer: Because most of the amputation occurred before the patient arrived in the emergency department, you should opt for a debridement code.
 
The patient's injury calls for a debridement and simple closure, which you should report with 11044 (Debridement; skin, subcutaneous tissue, muscle, and bone), because the physician definitely debrided not only the skin but also the muscle and bone. Because he then closed the defect, you should add a simple laceration code from the 12001-12007 series to cover the extra work of the closure - in this case, 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities; 2.6 cm to 7.5 cm).
 
The debridement-plus-closure code assignment is very safe from a coding perspective, but reporting a single, appropriate code might increase payment advantages. Depending on documentation, consider using the complex laceration code 13132 (Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm).