ED Coding and Reimbursement Alert

Question: A 67-year-old woman presents after falling in her kitchen. She was feeling dizzy after quickly looking up at the smoke alarm that had gone off from some smoke caused by burning toast in the oven. She suffered minor bruising and a 1.7 cm laceration on her left cheek from hitting the counter on her way down to the floor. The emergency physician performs an examination consistent with a level 3 ED visit seeking the reasons for the fall and verifying no additional injuries needing treatment. He diagnoses the reason for the fall as vertigo and cleans the cheek wound before deciding to close it using Dermabond adhesive. What is the proper coding for this scenario?

Answer: Because the patient is of Medicare age, you need to report the simple repair using the G code G0168 (Wound closure using tissue adhesive[s] only) for the tissue adhesive rather than the CPT code 12011 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less). 

Whereas CPT® identifies use of “sutures, staples or tissue adhesives (e.g., 2-cyanoacrylate)” as acceptable repair methods, CMS requires the use of the G code to more accurately capture the work involved with use of the adhesive rather than a formal suturing process.  Clinically, adhesives are frequently used in short, simple repairs on a body area that does not flex very much. 

On the claim, you would report: 

99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components, an expanded focused history, and expanded problem focused examination and medical decision making of moderate complexity),

Append Modifier 25 to the E/M to show it was separately identifiable from the laceration repair

G0168 (Wound closure using tissue adhesive[s] only) for the cheek repair, 

ICD 9 code 780.4 (Dizziness and giddiness) to 99283 for the vertigo  

ICD 9 code 873.41 (Other open wound of the head, face, without mention of complication; cheek) to G0168. 

For ICD-10, the codes would be R42 (Dizziness and giddiness) and S01.402A (Unspecified open wound of left cheek and temporomandibular are, initial encounter)