ED Coding and Reimbursement Alert

Question: A 17 year-old male reports to the ED after a bad fall from a skateboard. He has cuts containing heavy contamination of gravel and dirt on both knees, along with lacerations on his right hand and forehead. The physician makes the following repairs: 3.2 cm intermediate repair on left knee; 2.2cm intermediate repair on right knee; 3.0cm simple repair on right hand; 1.5cm simple repair on forehead. (There is no mention of complications or tendon involvement in any of the injuries.) How many CPT® codes should I report for this encounter?

Colorado Subscriber

Answer: This case requires three codes to report the various repairs: One code to represent both knee injuries, one for the hand repair and another for the forehead injury.

On the claim, report the following codes:

• 12032 (Repair intermediate of wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet; 2.6cm to 7.5cm) for the repairs to the left and right knees, because of the heavy contamination of debris in both those wounds
• 891.0 (Open wound of knee, leg [except thigh] and ankle; without mention of complication) linked to 12032 to represent the patient’s knee injuries.
• 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet 2.6cm to 7.5cm]) for the hand repair
• 882.0 (Open wound of hand except finger[s] alone, without mention of complication) linked to 12002 to represent the hand injury.
• 12011 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5cm or less) for the forehead repair.
• 873.42 (Open wound of face, without mention of complication; forehead) linked to 12011 to represent the forehead injury
• E885.2 (Fall from skateboard) linked to 12032, 12002 and 12011 to represent the cause of the patient’s injuries.

Explanation: When coding multiple laceration repairs, add the lengths of the repairs that occurred in the same anatomic area and are of the same complexity, then choose the appropriate code. Since both knee repairs were intermediate, you need to add up those lengths (3.2cm + 2.2cm) and report a single code.

The hand repair was simple, not intermediate, so you need to code separately for that procedure as well. Lastly, the simple forehead repair is in a different anatomical area than the other three, meaning you should code that one separately, too.

Depending on the payer, you may be required to add a modifier for these multiple lacerations.