ED Coding and Reimbursement Alert

Question: A patient reports to the ED with a laceration just above his right eyebrow; he reports that he fell and hit his head while skateboarding. During an expanded problem focused history and examination, the patient reports that he was knocked to the ground, but reports no loss of consciousness. The nonphysician practitioner (NPP) notes that the patient "does not reveal any concussive symptoms." Using butterfly strips, the physician closes the patient's 0.8 cm laceration, prescribes rest and Tylenol, and instructs the patient to follow up with his primary care physician (PCP) if the wound gets worse or he begins to experience any lingering pain in his head or neck. Is the wound closure separately reportable for this encounter?

Answer: You cannot report a separate wound repair code for this encounter. On the claim, report the following:

• The appropriate-level E/M code to represent the entire encounter, such as 99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity...)
• 873.42 (Other open wound of head; face, without mention of complication; forehead) appended to the E/M code to represent the patient's eyebrow laceration
• 959.01 (Injury, other and unspecified; head, face, and neck; head injury, unspecified) appended to the E/M code to represent the patient's head injury
• E885.2 (Fall on same level from slipping, tripping, or stumbling; fall from skateboard) appended to the E/M code to represent the cause of the patient's injury.

Explanation: In order to report 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 this wound repair, the physician must use more than adhesive strips to close the wound.

For example, if the physician used staples or sutures to close the wound, you would be able to report 12011 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less) and an E/M code with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended.