ED Coding and Reimbursement Alert

Question: A patient presents to the ED with a persistent dialysis fistula bleed. Physician notes indicate a level-two ED E/M service in addition to these procedures:

"L antecubital fossa prepped w/chloroprep.

"Anesth. w/ lido. 2-3.0 prolene sutures placed at bleeding site.

"Good hemostasis achieved." What is the proper coding for this scenario?

Montana Subscriber

Answer: You should limit your reporting to an ED E/M code and a simple laceration repair code. On the claim, report the following:

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

99282 (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 low complexity ...) for the E/M service

Modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99282 to show that the E/M and laceration repair were separate services

No ligation? Though physician notes indicate that she performed a ligation, you should not code separately for this service. Simple ligation of a vessel in any open wound is considered part of any wound closure CPT® code.