Internal Medicine Coding Alert

AMA also alters wound repair coding language in new manual.

When you're looking for an injection code in 2009, you'll need to check out a new section of CPT 2009. You'll also need to note changes to wound repair and metabolic panel codes, and two new virtual critical care codes, as the new manual

takes effect Jan. 1, 2009.

CPT took the code "family" that formerly ranged from 90760-90779 and relocated it to the 96360-96379 code set. Perhaps most notable for internal medicine coders is the deletion of 90772 (Therapeutic, prophylactic, or diagnostic injection

[specify substance or drug]; subcutaneous or intramuscular); in 2009, be sure to report this type of injection with 96372. While the codes have been renumbered, the language is not different. Check out this crosswalk for some of the codes

in the set:Internal medicine coders can find a complete list of these crosswalked codes in Appendix M of CPT 2009. (This appendix contains all of the crosswalked CPT codes for 2009.)

CPT revised code descriptors for intermediate repairs (12031-12057) in 2009, says Jill M. Young, CPC-ED, CPC-IM, president of Young Medical Consulting LLC in East Lansing, Mich. In 2008, the codes represented "Layer closure of

wounds ... ." Next year, the descriptors will all begin with "Repair, intermediate ... ." The change comes in order to make descriptors for all three levels of repair uniform, Young reports. The other codes in the set represent "simple"

(12001-12021) and "complex" (13100-13160) repair, with no mention of "layers." This caused some coders to trip up when filing wound repair claims; "this change should remove any confusion," Young relays.

Check out CPT's description of intermediate wound repairs: "Require layered closure of one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition to the skin (epidermal and dermal) closure."

This additional guidance comes from the American Academy of Dermatology Association: "Intermediate repair codes are intended for instances when one or more layers of deep sutures are required to approximate or obliterate space remaining

within the subcutaneous tissue, while at the same time specifically excluding repair of deep fascia -- i.e., muscle-enveloping fascia" (http://www.aad.org/pm/managedcare/models_closure.html).

Also: "Single-layer closure of heavily contaminated wounds that require extensive cleaning or removal of particulate matter also constitute intermediate repair," explains Quinten A. Beuchner, MS, MDiv, ACS-FP/GI/PEDS, CPC, CCP, CMSCS,

president of ProActive Consultants LLC in Cumberland, Wis.