ED Coding and Reimbursement Alert

Question: A patient reports to the ED after he crashed while inline skating. He has cuts containing particulate matter on both knees, and his right hand and forehead are also cut. The physician makes the following repairs: 3.2 cm intermediate repair on left knee; 2.2 cm intermediate repair on right knee; 3.0 cm 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: Three: One code to represent both knee injuries; one for the hand repair and another for the forehead fix.

On the claim, report the following codes:

- 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 knee repairs

- 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]; 2.6 cm to 7.5 cm) 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 (Other open wound of head; face, without mention of complication; forehead) linked to 12011 to represent the forehead injury

- modifier 59 (Distinct procedural service) linked to 12002 and 12011 to show that these repairs are separate from the knee procedures.

- E885.1 (Fall from roller skates) 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. Because both knee repairs were intermediate, you need to add up those lengths (3.2 cm + 2.2 cm) 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.