Primary Care Coding Alert

Question: An established patient reports to the FP with a facial laceration just below the vermillion border of her lower lip and a laceration of the mucosal surface of the lip. Both injuries are superficial and require minimal cleaning. After a level-two E/M, the FP stitches both wounds closed. The lip laceration repair totaled 2.5 cm, and the surface cut repair was 2.0 cm. How should I code this scenario?

Minnesota Subscriber

Answer: Judging from your description, the physician performed simple laceration repair on both cuts. Since the wounds were of the same severity and in the same anatomic location, you should add the lengths of both repairs together and choose a code based on the sum (4.5 cm).

On the claim, report the following:

- 12013 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm) for the repair

- 873.43 (Other open wound of head; face, without mention of complication; lip) linked to 12013 to represent the lip laceration

- 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; and straightforward medical decision-making) for the E/M

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

- 873.43 linked to 99212 to represent the patient's injuries.