Primary Care Coding Alert

Question: An established Medicare patient reports to the FP after falling from the stairs on his front porch. He has a laceration on his lower right arm and is complaining of a headache. The FP cleans the wound, makes a 2.7-cm layered closure on the patient's arm, and uses sutures and Dermabond to close the wound. The FP then performs a problem-focused history and examination on the patient to address his headaches. Can I report the Dermabond repair code in this scenario?

Missouri Subscriber

Answer: You should not include the Medicare code for Dermabond repair (G0168, Wound closure utilizing tissue adhesive[s] only) in this scenario.
 
Why? If your FP uses sutures or staples and Dermabond to close a laceration repair site, you can report only the layered laceration repair code, and you should not report G0168.
 
Your claim would look something like this:

 - 12032 (Layer closure of wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.6 cm to 7.5 cm]) for the laceration repair.

 - 881.00 (Open wound of elbow, forearm and wrist; without mention of complication; forearm) linked to 12032 to represent the patient's arm injury.

 - E880.9 (Fall on or from other stairs or steps) attached to 12032 to represent the cause of the patient's arm injury.

 - 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem-focused history; a problem-focused examination; straightforward medical decision-making) for the E/M service.

 -  modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) attached to 99212 to show that the E/M service and the repair were separate.

 -  784.0 (Headache) linked to 99212 to represent the patient's headache.

 -  E880.9 linked to 99212 to represent the cause of the patient's headache.