ED Coding and Reimbursement Alert

Code Combos Vary on Multiple Repairs

So you're all set to tackle any type of wound repair the ED throws at you.

Not so fast: What do you do if the ED physician performs multiple repairs for the same patient? Check the encounter specifics. If the physician performs multiple laceration repairs for the same patient during the same encounter, coding will depend on the repairs' types and location, says Kevin Solinsky, CPC, CPC-I, CPC-ED, president and CEO of Healthcare Coding Consultants LLC, Added Value Billing Inc. in Gilbert, Ariz.

Do this: Add all repair lengths of the same complexity in the same anatomical area, Solinsky says. For example, the ED physician performs three separate, simple repairs on a patient's trunk: one is 12 cm, the other two are each 1.3 cm.

Since the fixes are all simple and in the same anatomical location, add up the lengths of the repairs (12.0 + 1.3 + 1.3 = 14.6) and choose one code -- 12005 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 12.6 cm to 20.0 cm) -- for all three repairs.

But suppose the physician performs a simple, 4.1-cm repair to a patient's right foot, and then performs an intermediate repair on a separate 1.3-cm injury in the same anatomical area.

In this scenario, you'll need two codes. On the claim, you would report the following:

• 12041 (Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less) for the intermediate 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 simple repair

• modifier 51 (Multiple procedures) appended to 12002 to show the multiple nature of the repairs -- if the payer requires it.

Coders also need to report separate codes for wound repairs the physician makes in different anatomical locations -- even when the repairs are of the same severity.

Example: The notes indicate that the ED physician made the following repairs:

• a 3.1 cm simple face repair

• a 2.2-cm simple neck repair.

On the claim, you would report the following:

• 12013 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm) for the face fix

• 12001 (Simple repair of wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less) for the neck repair.