ED Coding and Reimbursement Alert

Question: A patient reports to the ED with two cuts on his right forearm: a deep 6-cm laceration near the elbow, and a 3-cm superficial laceration near the wrist. After a level-three E/M, the physician preps and drapes the patient's arm, performs layered closure on the deep wound, and a single-layer closure on the shallow wound. There was not complication or tendon involvement in either of the injuries. Can I report two surgical codes for this encounter? Tennessee Subscriber Answer: You should be able to report two surgical codes for this encounter. But since the physician only had to prep a single area for both procedures, you should include modifier 51 (Multiple procedures). On the claim, report the following: - 12032 (Layer closure of wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.6 cm to 7.5 cm) for the layered repair - 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.6 cm to 7.5 cm) for the single-layer repair - 884.0 (Multiple and unspecified open wound of upper limb without mention of complication) linked to 12032 and 12002 to represent the patient's injuries - modifier 51 appended to 12002 to show that the repairs were separate - 99283 (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 moderate 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) appended to 99283 to show that the E/M and surgeries were separate services - 884.0 linked to 99283 to represent the patient's injuries.