Medicare Compliance & Reimbursement

Hint: Anatomic classifications get smaller as repairs get more complex On your laceration claims, be sure to prove that the physician provided care that qualifies for the laceration repair codes. Medicare also has some different rules for certain repairs using Dermabond -- if you code these encounters as you would for a private payer, you'll likely end up with a denial. Make sure service qualifies: When the physician treats lacerations, you might be tempted to flip to CPT's laceration repair section and choose a code. But before you do that, you'll need to make sure that the service meets the payer definition for a repair. If the physician uses staples, stitches or sutures to close a wound, you can code laceration repair. But if the physician (or staff) uses only steri-strips, or some other kind of adhesive strip, to close the wound, you should consider the work an E/M service, says Kevin Solinsky, CPC, CPC-I, CPC-ED, president and CEO of Healthcare Coding Consultants LLC, Added Value Billing Inc. Use an E/M code "when the adhesive strips are the sole repair material. If the adhesive is used in addition to sutures, staples or tissue adhesives, then report the appropriate [laceration] repair code," says Kevin Arnold, CPC, business manager for the Emergency Medicine Department at Connecticut's Norwalk Hospital. Watch anatomy groupings: Next, you should check the body area being treated. CPT groups laceration repair by anatomical location -- with a twist. The grouping of anatomical locations for repair codes "depends upon which type of laceration repair you are doing," says Holly Barrett, CPC, CPC-H, ED and outpatient surgery coder at Northeastern Vermont Regional Hospital in St. Johnsbury. Check out these different anatomical breakdowns for laceration repair: Simple laceration groups: • Codes 12001-12007: Scalp, neck, axillae, external genitalia, trunk or extremities (including hands and feet) • Codes 12011-12021: Face, ears, eyelids, nose, lips or mucous membranes. Intermediate laceration groups: • Codes 12031-12037: Scalp, axillae, trunk or extremities (excluding hands and feet) • Codes 12041-12047: Neck, hands, feet or external genitalia • Codes 12051-12057: Face, ears, eyelids, nose, lips or mucous membranes. Complex laceration groups: • Codes 13100-13102: Trunk • Codes 13120-13122: Scalp, arms or legs • Codes 13131-13133: Forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands or feet • Codes 13150-13153: Eyelids, nose, ears or lips. Example: A patient with a simple 2.2-cm laceration on her nose presents to the physician. On the claim, you would report 12011 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less). Medicare exception: When coding simple repairs for Medicare patients, be on the lookout for Dermabond. If the physician uses Dermabond as the only closure material for a [...]