Podiatry Coding & Billing Alert

Wound repair using only adhesive strips should be reported with an E/M code.

In the recent session “Skin Repairs and Grafts” during HEALTHCON Regional 2022, speaker Corrie Alvarez, CPC, CPC-I, CEDC, CPMA, CEMC, CRC, CPCO, shared tips for how to report laceration repairs. Details you need to look for in the documentation include the length, complexity, and site of the wound.

Editor’s note: Stay tuned next month to learn how to report adjacent tissue transfer (ATT) and skin replacement surgery and skin substitutes.

First, Understand How Skin Layers Function

The epidermis is the top layer of skin, and it is made up of four to five layers, according to Alvarez. The function of the epidermis is protection.

The dermis is the middle layer of skin and contains blood vessels, connective tissue, and nerves, Alvarez, said. The subcutaneous tissue is fat. It contains connective and adipose tissue and acts as a shock absorber.

Consider These 3 Factors

You must take the following three factors into consideration when reporting a laceration repair, per Alvarez:

1. Length of the wound in centimeters. The wound should be measured and recorded in centimeters. “A lot of physicians will still document in inches, although we try to have them complexity and anatomic classification, according to Alvarez.

2. Complexity of the wound you are repairing. Is it a simple repair, where there is just one layer of closure? Or is it a layered closure, where there are some sutures in the middle and then some sutures at the top? Or is it a highly contaminated wound?

3. Site of the wound

“Wound closure includes sutures, staples, or tissue adhesive,” Alvarez said.

“Tissue adhesive is not a Band-Aid, a butterfly, or an adhesive. It is a chemical,” per Alvarez. Physicians use tissue adhesive for low-tension wounds and some higher tension wounds. Tissue adhesive is easy and painless for patient, and there is no follow-up. Medicare allows G0168 (Wound closure utilizing tissue adhesive(s) only) for wound closure with tissue adhesive.

Tissue adhesive is a very good tool to use as long as the wound is not infected and it’s been only a few hours since the laceration, Alvarez added.

Don’t miss: Wound repair using only adhesive strips should be reported with an evaluation and management (E/M) code.

Coding alert: If extensive debridement is required, use codes 11042 (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less)-+11047 (Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)), Alvarez said.

Take a Look at Different Types of Repairs

Different types of repairs include the following, Alvarez said:

• Simple: superficial wound/simple one-layer closure. This includes local anesthesia.
• Intermediate: Elements of simple repair plus layered closure of deeper layers of subcutaneous tissue.
• Complex: Complicated wound closure includes debridement/stents. More than a layered closure.

Alvarez shared the following table, which is a decision tree physicians use when deciding what type of suture to use in wound repair:

Discover Different Suture Types

Physicians also must decide whether they are going to use dissolvable or non-absorbable sutures, Alvarez said. Dissolvable sutures include vicryl rapide (two weeks), undyed moncryl (three weeks), dyed mocryl (four weeks), and coated vicryl (five weeks). Non-absorable sutures include nylon, polypropylene, and silk.

Different suture patterns include simple interrupted, running, mattress, and running subcuticular sutures, Alvarez said.

Physicians decide what type of sutures to use and how to repair a wound by considering how deep the wound is, how contaminated the wound is, if there is any bleeding, and the location, Alvarez explained.

Put it All Together With An Example

Alvarez offered the following example of laceration repair: A 30-year-old patient was at a sports gymnasium, participating in a tap-dancing contest to raise funds for muscular dystrophy. The patient slipped and fell on the gym floor, sustaining a 2.0 cm laceration on the forehead, 2.5 cm laceration on the scalp, 1.5 cm laceration on the right forearm, 1.5 cm laceration on the right foot, 3.0 cm laceration on the left leg, and a 1.5 cm laceration on the chin. The left leg and chin needed layer closure. The patient will follow up with their provider in three days.

Answer: Report the following codes on your claim:

• 12032 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm)- (Left side) for the 3.0 cm leg, intermediate repair.
• 12051 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less)-59 (Distinct procedural service) for the 1.5 cm chin, intermediate repair.
• 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cm)-59-RT (Right side) for the scalp, forearm, and right foot equals a 5.5 cm simple repair.
• 12011 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less)-59 for the 2.0 cm forehead repair.

Modifier alert: Don’t forget to append modifier 59 (Distinct procedural service) to indicate that more than one classification has been listed.