Pediatric Coding Alert

Determine how you would code these laceration repairs

If you're still unsure about how to report laceration services, now is the time to brush up on your coding.
 
Test your laceration coding knowledge before you submit that next laceration claim. Write either true or false in the blank next to the questions and then check the answers coding experts provided.
 
1. When you report multiple codes for dissimilar repairs, you always should unbundle the codes with modifier -59. _______________
 
2. Your pediatrician repairs a 4.4-cm superficial wound on a patient's chest and a 6.2-cm simple laceration on the patient's neck. He classifies the wound in the same class and in the same anatomic site. You should add the measurements as 4.4 cm + 6.2 cm = 10.6 cm and report 12004. ________________
 
3. A pediatrician treats a 2.1-cm cut that he or she describes as a superficial wound that primarily involves the epidermis or dermis, so you should report 12031.
 
4. Your physician performs an intermediate repair. He should include terms such as "layered closure," "deep layer suturing" or "extensive debridement" in the chart notes. ____________
 
5. CPT lumps all laceration codes into the same body groupings or class. ___________

Check Your Work
 
1. False. The modifier depends on the laceration codes and whether the payer follows the National Correct Coding Initiative (NCCI). When you assign codes for repairs that belong to different classifications or groupings, you should append modifier -51 (Multiple procedures) to the less complicated procedure as long as NCCI doesn't bundle the codes or the insurer doesn't follow the edits. If the payer adopts NCCI and the edits bundle the laceration codes, you should append modifier -59 (Distinct procedural service), not modifier -51, to the secondary procedure.
 
2. True. Always pay attention to CPT body groupings because they change based on the repair's class. In the question, you would use 12004 because your pediatrician performed repairs in the same class (simple) and in the same anatomic site.
 
3. False. The proper code is 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.4 cm or less). Look for descriptions such as "superficial" and "primarily involves epidermis or dermis" when you report simple repair codes.
 
4. True. Intermediate laceration services include layered closures, deep layer suturing and extensive debridement, so make sure to document these carefully.
 
5. False. CPT puts laceration services into three classes: simple, intermediate and complex. Also, CPT classifies lacerations into different body groupings. For example, CPT includes hands, feet and/or extremities in the same anatomic site for simple repairs (12001-12007). The intermediate repairs codes for extremities (12031-12037) exclude hands and feet.