Pediatric Coding Alert

Question: Our provider saw a 7-year-old who cut their left foot on a broken wood shard while diving off a dock. The wound is 1.2 cm. long. The pediatrician used adhesive strips to close the wound. What wound repair code is appropriate for this?

Vermont Subscriber

Answer: This would be reported with an appropriate office/outpatient evaluation and management (E/M) code rather than a wound repair code. The need for adhesive strips implies that while the wound is a little deeper than a standard cut it’s not so deep it needs sutures, so you probably have a solid case for coding 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making …), assuming the patient is established to your practice.

Why? Medical decision making (MDM) in this scenario would only rise to a straightforward level based on the patient presenting with a single, self-limiting problem; the treatment for that problem creating minimal risk of complications or morbidity to the patient; and there being minimal or no data for your pediatrician to review or analyze.

Coding alert: For patients covered by Medicaid, you might use HCPCS code G0168 (Wound closure utilizing tissue adhesive[s] only) instead.