ED Coding and Reimbursement Alert

Question: An elderly patient presented to the ED with a 1.4-centimeter skin tear on his left thigh. The ED doctor cleaned the tear and used Dermabond to repair it. How should I code this encounter?


Mississippi Subscriber

Answer: Although CPT specifically mentions closure with tissue adhesives as a method of repair, correct code use depends on the patient's insurer.
 
When the physician performs a single-layer closure on a patient, private carriers and Medicare have different expectations of the coder.

If Medicare insures the patient, you should report G0168 (Wound closure utilizing tissue adhesive[s] only) for the encounter.

However, if the patient has a non-Medicare insurer, you-ll need to select a code from the series for simple laceration repairs, depending on the length of the repair. In this instance, you would report 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less) on the claim for a non-Medicare carrier.

Remember that successful wound care claims document the exact measurement of the repair. Make sure your physician documents wound length, in centimeters, in her notes.