Pediatric Coding Alert

When you repair a laceration, four elements determine the correct code:

1. Classification: determine whether a repair is simple (superficial), intermediate (deeper layers), or complex (not likely in an ambulatory pediatric practice)

2. Size: measure the size in centimeters of the repaired wound

3. Location of the injury: should be used to arrive at the final code selection

4. Number: if multiple. Classification Determines Location

The site groupings differ slightly for each classification: Simple repair (12001-12021) includes two basic groups: 12001-12007 (scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]) and 12011-12018 (face, ears, eyelids, nose, lips and/or mucous membranes). Intermediate repair includes three groups: 12031-12037 (scalp, axillae, trunk and/or extremities [excluding hands and feet]), 12041-12047 (neck, hands, feet and/or external genitalia), and 12051-12057 (face, ears, eyelids, nose, lips and/or mucous membranes). Note: For multiple laceration repairs, add lengths within each classification from sites in the same grouping. For example, add two simple laceration repairs on the arm, but do not add one simple laceration on the face and one simple laceration on the arm, or one simple laceration on the face and one intermediate laceration on the face. Case Study An 8-year-old boy fell off his bike and has a 2-cm superficial laceration on the forehead, a 1-cm-deep laceration on the forehead, a 2-cm superficial laceration on the forearm, and a 2-cm superficial laceration on the knee. The pediatrician elects to perform the repairs in the office.

List laceration repair codes in order of severity, explains Jeffrey Linzer Sr., MD, FAAP, MICP, professor of pediatrics at Emory University, AAP representative to the ICD-9-CM editorial advisory board, and AAP coding and reimbursement committee liaison.

In this case, one laceration is intermediate; the others are all simple. The deep laceration on the forehead requires a two-layer repair. Because it is the only intermediate repair on the face, and it's less than 2.5 cm, report this repair with 12051* (Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less), says Linzer, who is also director of emergency medicine at Children's Healthcare of Atlanta and Hughes Spalding Children's Hospital. Use 873.42 (Other open wound of head; face, without mention of complication; forehead) for the diagnosis to accompany the repair. Do not add the two facial lacerations, because one is intermediate and one is simple. Code the other facial laceration next. It is only a one-layer repair, which qualifies as simple, and it's less than 2.5 cm. Report 12011* (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less). Again, use 873.42. Both other lacerations forearm and knee are single-layer repairs. In this case, two simple repairs [...]