ED Coding and Reimbursement Alert

Question: I am having some trouble coding this laceration repair scenario: A patient reports to the ED with a facial laceration just below the vermillion border of her lower lip; she also has a laceration of the mucosal surface of the lip. Notes indicate both injuries are superficial and require minimal cleaning. After a level-two E/M, the ED physician stitches both wounds closed.

Minnesota Subscriber

Answer: Judging from your description, the physician performed simple laceration repair on both cuts. Since the wounds were of the same severity and in the same anatomical location, you should add the lengths of both repairs together and choose a code based on the sum (4.5 cm).

On the claim, report the following:

- 12013 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm) for the repair

- 873.43 (Other open wound of face, without mention of complication; lip) linked to 12013 to represent the lip laceration.

- 873.40 (Other open wound of face, without mention of complication; unspecified site) linked to 12013 to represent the mucosal laceration

- 99282 (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 low complexity) for the E/M

- 873.43 and 873.40 linked to 99282 to represent the patient's injuries.

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