ED Coding and Reimbursement Alert

Answer: All lacerations billed to Medicare should include an evaluation and management (E/M) service. Other carriers wont accept an E/M code with a laceration. When submitting an E/M service with a laceration, the documentation must support a significant, separately identifiable service. This may be the case, for instance, when a patient falls and suffers a head laceration, and the physician must determine whether a closed head injury was sustained, or when the patient has other injuries or problems that require a lot of evaluation. But there are other times when the injury is straightforward and the only thing the physician does is evaluate the laceration for foreign body, verify the immunization status, then clean and repair the wound. These are considered standard steps in wound care, and do not justify the use of a separate E/M service.