Wiki Missing laceration length

[KRZollinger67]

We have a debate going on with providers. They state that if the laceration length is not stated, we should code the lowest level for example 12001 where it shows "2.5 cm or less". I am not in agreement. I believe that the length of wound is one of the necessary pieces of information needed to choose the proper laceration repair code. Can anyone shed some light on this area? Am I overthinking this? Is the "or less" in the code description enough to cover it if no length documented? Thanks for your input.

 

[Orthocoderpgu]

As a practical matter if the length is not stated then you would default to the code for the smallest length. However, your providers need to understand this. You don't want to bill the smallest code when the provider performed more work. Make sure they understand that without the length being documented they will get the shortest code. Best practice is to always document the length though.

 

[KRZollinger67]

As a practical matter if the length is not stated then you would default to the code for the smallest length. However, your providers need to understand this. You don't want to bill the smallest code when the provider performed more work. Make sure they understand that without the length being documented they will get the shortest code. Best practice is to always document the length though.

Thank you.

 

[thomas7331]

We have a debate going on with providers. They state that if the laceration length is not stated, we should code the lowest level for example 12001 where it shows "2.5 cm or less". I am not in agreement. I believe that the length of wound is one of the necessary pieces of information needed to choose the proper laceration repair code. Can anyone shed some light on this area? Am I overthinking this? Is the "or less" in the code description enough to cover it if no length documented? Thanks for your input.

I'm not aware of any 'official' guidance one way or the other on the answer to this question, but at the practices where I've worked, we were allowed to assign the code for the minimum size or length in cases where it was not documented. In my opinion, if the procedure is documented, then that supports assigning a code for the minimum since the records shows that a closure was done and meets the qualification for the minimum code. The other option is to query the provider for the information, but that's a decision your practice needs to make since queries can delay your claims and create backlogs for the coders, and then you still need a policy for cases how to proceed when the query is not answered in a timely manner.

Incidentally, I'd just mention that it's not the length of the laceration that you need documented for code assignment, it's the length of the closure. A closure may be shorter or longer than the actual laceration itself.

 

[KRZollinger67]

I'm not aware of any 'official' guidance one way or the other on the answer to this question, but at the practices where I've worked, we were allowed to assign the code for the minimum size or length in cases where it was not documented. In my opinion, if the procedure is documented, then that supports assigning a code for the minimum since the records shows that a closure was done and meets the qualification for the minimum code. The other option is to query the provider for the information, but that's a decision your practice needs to make since queries can delay your claims and create backlogs for the coders, and then you still need a policy for cases how to proceed when the query is not answered in a timely manner.

Incidentally, I'd just mention that it's not the length of the laceration that you need documented for code assignment, it's the length of the closure. A closure may be shorter or longer than the actual laceration itself.

Thank you!