Internal Medicine Coding Alert

Question: The internist treats an established patient with a cut on her lip. Using Dermabond, he closes the 1.8-cm laceration. Should I use a laceration repair code when the only adhesive the physician uses is Dermabond?

Nebraska Subscriber

Answer: Your code choice will depend on the patient's insurance. Check out these two coding options:

Patient has Medicare: If the physician uses Dermabond as the only closure material for a simple repair on a Medicare patient, report G0168 (Wound closure utilizing tissue adhesive[s] only) for the service.

Patient has commercial insurance: If the commercial carrier follows Medicare rules, use G0168. However, if the payer does not observe Medicare guidelines, you'll most likely choose a laceration repair code, even when Dermabond is the only adhesive the internist uses. On the claim, report 12011 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less).

Either way: Append 873.43 (Other open wound of head; face, without mention of complication; lip) to the procedure code to represent the patient's injury.