Wiki laceration repair needs E/M?

Create Wiki
T

tag60

Guru
Messages
150
Location
Santee, CA
Best answers
0
I don't know why I'm having so much trouble deciding whether to code an E/M visit in which a laceration repair (12002) is done. (Yes, newbie here.) I've read posts and articles and guidelines...still uncertain. An experienced co-worker told me since this is a new problem and first time evaluated and decided to do the repair, I would pick up an E/M with modifier -25 as well as the procedure code for the repair.

But, from CMS.gov, Global Surgery Fact Sheet (Medicare): For some minor procedures (as with 0 or 10-day globals), "visit on day of the procedure is generally not payable as a separate service."

The patient fell from a bike. The SOAP note focuses entirely on what happened, exam of injured areas, and then a description of repair of a 6 cm laceration on chin. TDaP given, strict wound precautions given. (end of note)

I will code as: 873.44, 12002

Do I also code E/M visit with modifier -25?

Thanks in advance!
 
As per your question, this is a new problem and first time evaluated and decided to do the repair. Its appropriate to bill a proper E/M code with modifier -25 as well as the procedure code for the repair, if provider performed a significant E/M service in addition to procedure code.
If the reason for encounter was solely for repair of laceration and no significant Evaluation and Managemnt of patient was performed, then E/M code with modifier 25 will not be appended. In this situation, E/M will be considered as a component of repair. I hope this will help.
 
Even with a new problem if the evaluation is not over and beyond the need for the procedure then you cannot charge a separate E&M. Every procedure has as an inherent part the evaluation necessary to perform the procedure. If the evaluation does not include examination of other areas to look for more injuries then you do not have a separately identifiable evaluation so only the repair is billed.
 
Well, yes, more was assessed, but all in relation to the injury. Here's the exam:

Vital signs stable. HEENT: Abrasions over left side of face with 6 cm laceration at angle of chin. EOMI, PERRLA. Nontender except laceratoin. No bony tenderness. Tongue full movement. No teeth tender or loose. No defect to lac palpated interiorly.
Neck: Supple with no tenderness.
Skin: Left arm with multiple abrasions.
(Then describes suture of chin lac)

Provider's assessment: Open wound of chin, 873.44.

I'm still uncertain if this warrants a separate E/M. I appreciate any further feedback and apologize for being so thick-headed!

Thank you!
 
This qualifies for a separate e/m. You didn't include the history, but at least in the exam the provider is documenting the evaluation of a patient who fell off a bike--not just the evaluation of a laceration. The physical includes additional detail pertinent to an injury assessment but unrelated to the procedure such as EOMI and PERRLA. The procedure was unplanned prior to patient evaluation. The evaluation itself determined the need for the specific procedure including the type of closure (whether it was layered, or sutures plus wound adhesive, etc).

See FAQ 3: http://www.acep.org/Clinical---Practice-Management/Surgical-Package-FAQ/

See example 1: http://news.aapc.com/same-day-em-and-office-procedure-yes-you-can/
 
You must log in or register to reply here.
Top