ED Coding and Reimbursement Alert

Question: A construction worker who was using a table saw reports to the ED with lacerated index and middle fingers on the palmar surface, but there is no significant bleeding and he is otherwise healthy. On the pad of the distal phalanx of both involved fingers is a 1.5-cm laceration that is jagged with protruding fat. Our physician applies digital blocks to both fingers with Marcaine, explores the wounds for foreign bodies (none found) and closes the wounds. How should I code this encounter?


Indiana Subscriber


Answer: To code this claim correctly, you-ll need help from a pair of E codes to identify the cause of the patient's injury.


On the claim:

- report 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 wound closure.

- report 99283 (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 moderate complexity) for the E/M service.

- 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 99283 to show that the E/M and the wound closure were separate services.

- attach 883.0 (Open wound of finger[s]; without mention of complication) to 12002 and 99283 to represent the patient's cut fingers.

- attach E919.4 (Accidents caused by machinery; woodworking and forming machines) to 12002 and 99283 to represent the external cause of the patient's accident.

- attach E849.3 (Place of occurrence; industrial place and premises) to 12002 and 99283 to represent the location of the patient's accident.