ED Coding and Reimbursement Alert

Question: A mother brings her 10-year-old daughter to the ED. The child fell from her bike and had a laceration on her left knee. The physician examines the patient, cleans the wound and closes it using butterfly bandages. Can we report a laceration repair code for this encounter?

Montana Subscriber

Answer: If the wound does not require stitches, staples or tissue adhesive (such as Dermabond), you should not report a laceration repair code. CPT requires you to use one of these closure methods in order to report 12001-12007 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet] ...).

Solution: Roll the work the physician performs closing the laceration into the overall E/M level for the visit. So if notes indicate a level-two E/M, you should report the following:

- 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.

- 891.0 (Open wound of knee, leg [except thigh], and ankle]; without mention of complication) linked to 99282 to represent the laceration

- E826.1 (Pedal cycle accident; pedal cyclist) linked to 99282 to represent the cause of the laceration.