General Surgery Coding Alert

Tissue adhesives hold many advantages for the general surgeon and patient. They align and seal injured tissue without the use of sutures or staples; promote natural healing; cost less and prove easier and quicker to use than traditional closure methods; and, in some cases, can save the patient a follow-up visit to the doctor. Coding for tissue adhesives poses certain challenges, considering the fact that Medicare and private payers do not share a standard billing procedure for these repairs and such repairs are often reported as part of other integumentary system procedures. Coders should consider the following before coding for tissue adhesives:
 
Who covers the patient (Medicare or a private payer)?
 
What other procedures or services were performed?
Who Covers the Patient?
Tissue adhesive repair has had a bumpy coding history since the FDA approved Dermabond (the first and best-known adhesive product) in 1998. CPT did not include tissue adhesives in any of its code descriptors before 2000; an unlisted code was used to report such repairs. CPT 2000 revised the wording in the wound closure section to indicate that "tissue adhesives, either singly or in combination with each other, or in combination with adhesive strips, should be reported using the appropriate existing wound closure code." CPT notes, for example, that if Dermabond is used to close a 3-cm facial laceration that does not require extensive cleansing or removal of particulate matter, the service should be reported using 12013 (simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm).
 
Furthermore, CPT did not limit the use of repair codes for tissue adhesive application to "simple" repairs (one layer closure without extensive cleansing or removal of particulate matter). If more extensive closure is required, the appropriate intermediate or complex closure code may be reported even if tissue adhesive is applied to close the skin.
 
Shortly after CPT 2000 was published, however, CMS introduced G0168 (wound closure utilizing tissue adhesive[s] only) and instructed providers to use this code instead of the existing CPT codes when billing Medicare Part B carriers. The American Medical Association (AMA), the American College of Surgeons (ACS) and other physician groups criticized these guidelines, arguing that the code was introduced without consulting either the AMA or the ACS. The ACS claimed that introducing G0168 was contrary to the CPT 2000 revision, which instructed physicians to use existing codes. The ACS also noted that the reimbursement level for G0168 is about half that for the simple repair codes, because Medicare regards tissue adhesive closure as a simpler technique.
 
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