ED Coding and Reimbursement Alert

Question: A patient reports to the ED with facial cuts. The physician performs a simple 2.5-cm repair to a laceration of the eyebrow, and then fixes a 3.2-cm laceration on the patient's forehead (also simple repair). On this claim, should I report separate codes for each repair?

Minnesota Subscriber

Answer: No, you should report a single code for both of these fixes. When the physician fixes wounds of the same complexity in the same anatomical area, you should add the lengths together and then choose a CPT code accordingly.

Sum length: The physician made simple repairs of 2.5 cm and 3.2 cm in the same body area, for a sum length of 5.7 cm.

On your claim:

- report 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.6 to 7.5 cm) for the repair.

 - attach 873.49 (Other open wound of head; face, without mention of complication; other and multiple sites) to 12002 to represent the patient's injuries.

Exception: If the repairs are in different anatomical areas -- or the repairs are of varying complexity in the same area -- then you should report separate codes for each repair.

So in the above example, if the 3.2-cm forehead repair was intermediate and the 2.5-cm eyebrow fix was simple, you would:

 - report 12052 (Layer closure of wounds of face, ears, eyelids, nose, lips, and mucous membranes; 2.6 cm to 5.0 cm) for the forehead repair.

 - report 12011 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips, and/or mucous membranes; 2.5 cm or less) for the eyebrow repair.

 - attach modifier 51 (Multiple procedures) to 12011 to show that the physician performed multiple repairs.

 - link 873.49 (Other open wound of head; face, without mention of complication; other and multiple sites) to 12052 and 12011 to prove medical necessity for the procedures.