Pediatric Coding Alert

Several readers have written to us in the past two weeks questioning our recommendation in the January 1999 issue of PCA to continue coding with the laceration repair codes, even when the procedure is performed using the tissue adhesive, Dermabond, instead of or in conjunction withsutures.

Since there is currently no code to report closure by this method, CPT Assistant recommends the use of 17999, unlisted procedure for skin, mucous membrane, and subcutaneous tissue, writes Pam Risavy, ART, coding compliance coordinator, BJC Medical Group, noting a response to a reader question published in the December 1998 issue of that publication. Since CPT Assistant is published in conjunction with CPT, by the AMA, your readers might be interested in this information.

Currently, there is no official recommendation by the American Medical Association on how to report laceration repair with Dermabond, states Grace Kotowicz, director of the AMAs department of coding and nomenclature.

The associations CPT editorial panel, which is responsible for putting together CPT, is meeting the first week of February and the issue of coding for Dermabond is on their agenda, she adds. When they have established the correct way to report, then we intend to publish a recommendation for our members.

Until then, Kotowicz says, any procedure that is not covered in CPT should be reported with the unlisted procedure code until the editorial panel recommends a course of action. That is what I would say for any situation like this.

However, physicians and coding experts consulted by PCA advise that the code definition for laceration repair does not specifically state that the laceration must be closed with sutures alone. The code definition only specifically excludes their use when staples are used as a suture material. They contend the code definition of laceration repair would include repairs made with Dermabond as the suture material.

In addition, most carriers do not pay for unlisted procedure codes, so billing laceration repair as an unlisted procedure can have significant impact on a practices reimbursement.

If your practice uses Dermabond for simple laceration repair, the coding experts we consulted continue to recommend billing using the laceration repair codes until the CPT committee recommends otherwise.
Once the panel makes its recommendation, the AMA expects to have an advisory to physicians by March, Kotowicz states.