ED Coding and Reimbursement Alert

Question: A patient came in with a laceration of the finger and nail bed. The physician removed the nail plate and performed a nail bed repair, and then performed another 2.5-cm suture to the length of the finger (it was all one laceration). How should Icode this?

Tennessee Subscriber

Answer: For the avulsion of the nail itself, consider code 11730 (Avulsion of nail plate, partial or complete, simple; single), depending on your carrier's policy. Most payers feel that the removal of the nail is a component of the nail bed repair.

For the nail bed repair, you should report 11760 (Repair of nail bed), and assign 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less) for the laceration repair. Be sure to append modifier -51 (Multiple procedures) to 12001 to show that the doctor performed multiple related procedures.

You'll need to assign the proper evaluation and management code -- probably 99282 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history, an expanded problem-focused examination, and medical decision-making of low complexity) or 99283 (... medical decision-making of moderate complexity), depending on the extent of the history, exam, and medical decision-making your physician documented. Don't forget to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to show that the E/M service was separate.