ED Coding and Reimbursement Alert

Question: A patient reports to the ED with a pair of lacerations; notes indicate that after a level-two E/M service, the nonphysician practitioner (NPP) performed a simple 3.5cm laceration repair on the patient's right foot and a simple 4.3cm laceration on the patient's right thigh. How should I report the encounter?

Illinois Subscriber

Answer: On the claim, report the following:

• 12004 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 7.6 cm to 12.5 cm) 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 low complexity medical decision making ...) 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 the laceration repair were separate services
• 890.0 (Open wound of hip and thigh; without mention of complication) appended to 99282 and 12004 to represent the patient's thigh injury 892.0 (Open wound of foot except toe[s] alone; without mention of complication) appended to 99282 and 12004 to represent the patient's foot injury.

No separate codes: In this scenario, both repairs were simple and located in the same anatomical locations for coding purposes. When laceration repairs occur in the same anatomical location and are of the same severity, you'll often combine the codes and report a single code based on total repair length (3.5cm + 4.3cm = 7.8).