ED Coding and Reimbursement Alert

When closure gets more complicated, 2-code claim possible
 
If your ED physician performs a lesion removal, he-ll also have to close the excision site before sending the patient home. If this closure represents a simple repair, the work involved is bundled into the lesion excision code you report on the claim.

However, if the repair of the excision site gets more complicated, you-ll be able to report the closure separate from the excision, says Pat Strubberg, CPC, of Patients First Health Care in Washington, Mo.

When the ED physician performs an intermediate closure, you-ll choose a code from the 12031-12057 set, says Sharon Richardson, RN, compliance officer with Emergency Groups- Office in Arcadia, Calif. For complex closures, you-ll choose from the 13100-13153 set.

Complex or intermediate repair can be common in the ED, especially if the physician has to cut deep enough during the excision. -For example, the physician is removing a cyst. He may also utilize subcutaneous sutures at the excision site so the wound will not fill up with fluid,- Richardson says.

Suppose the ED physician excises a benign lesion from a patient's right arm. Total excision area is 4.4 cm. To close the wound, the physician has to perform a 4.0-cm intermediate wound closure.


On the claim:

- report 11406 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter over 4.0 cm) for the lesion excision.

- report 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 excision site closure.

- attach modifier 51 (Multiple procedures) to 12032 to show that the site closure and the excision involved multiple procedures.