Primary Care Coding Alert

Question: If a physician performs a digital block on a finger and repairs a 2 cm laceration, would the correct codes for these procedures be 64450 (Injection, anesthetic agent; other peripheral nerve or branch) and 12001-51? Thanks for any help.

Virginia Subscriber

Answer: CPT® states that the digital block is included in the simple laceration repair code. The following services are always included in addition to the operation per se:

• Local infiltration, metacarpal/metatarsal/digital block or topical anesthesia
• Subsequent to the decision for surgery, one related Evaluation and Management (E/M) encounter on the date immediately prior to or on the date of procedure (including history and physical)
• Immediate postoperative care, including dictating operative notes, talking with the family and other physicians
• Writing orders
• Evaluating the patient in the post-anesthesia recovery area
• Typical postoperative follow-up care

Based on these guidelines, you'll report only 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less) without a modifier. Code 64450 is unnecessary. Include the appropriate E/M office code with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) if documentation supports that the repair was separately identifiable from any E/M service provided at the same encounter.