ED Coding and Reimbursement Alert

Question: We have gotten several denials in the past few months on our laceration repair claims. Each time, the insurer says that the documentation does not support the laceration repair. How can we improve our documentation of laceration repair encounters?

Kentucky Subscriber

Answer: You-ll need to go back and check how your physician documents his laceration repairs, and you will likely need to make a few changes. On laceration repair claims, the procedure note should include these elements:

- location 

- length

- layers

- decontamination (including foreign material removed)

- tissue management

- exploration of wound and contiguous structures

- anesthesia technique

- repair of underlying structures.

Example: A good procedure note for a simple scalp repair might read: "After cleansing with betadine, repaired single-layer scalp wound, 8.4 cm, with 14 4-0 prolene sutures under local anesthesia. No foreign material removed; no repair of underlying structures or tissue management required. Wound and surrounding structures checked, no further trauma found."

With this procedure note, you should have no trouble getting paid for 12004 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 7.6 cm to 12.5 cm).